title: Appropriateness of emergency department use in pediatric inflammatory bowel disease: a quality improvement opportunity.
abstract: OBJECTIVE
  We sought to characterize emergency department (ED) encounters for pediatric inflammatory bowel disease (IBD) to identify areas for prevention.
  
  
  METHODS
  Retrospective chart review of 5 consecutive ED encounters at 7 centers was performed.
  
  
  RESULTS
  Of 35 unique encounters by 32 patients, 3 main factors contributed to ED utilization: disease severity or course, day or time of care, and physician instruction. Of the ED encounters, approximately one-fifth were judged medically unnecessary, and one-half avoidable in a more optimal health care system.
  
  
  CONCLUSIONS
  ED visits by pediatric patients with IBD may be reduced in a more optimal health care system.
authors.affiliation: *Digestive Health Institute, Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora †Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California ‡Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio §Northwest Pediatric Gastroenterology LLC, Randall Children's Hospital, Portland, Oregon ||Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill ¶Children's Digestive Disease Program, Pediatric Digestive Diseases, Inova Fairfax Hospital for Children, Fairfax, Virginia #Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Eastern Virginia Medical School, Children's Specialty Group, Norfolk **University of Vermont College of Medicine, Burlington.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hoffenberg
authors.forename: K T
authors.initials: KT
authors.lastname: Park
authors.forename: Dana M
authors.initials: DM
authors.lastname: Dykes
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Fridge
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Ian H
authors.initials: IH
authors.lastname: Leibowitz
authors.forename: V Marc
authors.initials: VM
authors.lastname: Tsou
authors.forename: Richard B
authors.initials: RB
authors.lastname: Colletti
mesh_terms: D039602:After-Hours Care; D003695:Delivery of Health Care / Q000592:standards*; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D058996:Quality Improvement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors