title: Emergency department use among children with tracheostomies: Avoidable visits.
abstract: OBJECTIVE
  To characterize high emergency department (ED) use by children with tracheostomies and complex chronic conditions, to distinguish avoidable from unavoidable ED visits, and to describe the financial impact of avoidable visits.
  
  
  METHODS
  Children with tracheostomies in a pediatric tertiary care center with the highest ED utilization were identified via analysis of administrative data. Six experts in interdisciplinary dyads reviewed the records from all ED visits for these children, and distinguished avoidable from unavoidable visits. Hospital cost data for avoidable visits is described.
  
  
  RESULTS
  Among 75 children with tracheostomies and complex chronic conditions, 23 (31%) were high ED utilizers. These 23 children accounted for 74% of all ED discharges the total group of 75 children from 2008 to 2011. Four of these 23 children with high utilization were excluded, leaving 19 subjects for review. These 19 children had 312 ED visits, of which 103 (33%) were deemed avoidable. Leading reasons for avoidable visits were uncomplicated upper respiratory infections, gastrointestinal infections, and enteral feeding system problems. Avoidable visits cost the hospital {$}67,940.
  
  
  CONCLUSIONS
  One-third of ED visits by children with tracheostomies and complex chronic conditions may be avoidable. Increased ambulatory access to interdisciplinary teams of providers familiar with these children's unique needs might reduce avoidable ED visits and improve health outcomes. Further studies on how this model of ambulatory care might affect ED utilization and total healthcare costs are needed.
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Meier
authors.affiliation: Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.|Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT, USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Valentine
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hagedorn
authors.affiliation: Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Hartling
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: William
authors.initials: W
authors.lastname: Gershan
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Harlan R
authors.initials: HR
authors.lastname: Muntz
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics / Q000706:statistics & numerical data*; D014139:Tracheostomy / Q000191:economics; D014589:Utah
keywords: Child; emergencies; tracheostomy