Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients.
Emergency department (ED) utilization is a major driver of health care costs. Specialist physicians have an important role in addressing ED utilization, especially at highly specialized, academic medical centers. We sought to investigate whether reporting of ED utilization to specialist physicians can decrease ED visits.



This study analyzed an intervention to reduce ED utilization among ED patients who were followed by pediatric gastroenterologists. In May 2013, each pediatric gastroenterologist began receiving reports with rates of ED use by their patients. The reports generated discussion that resulted in a cultural and process change in which patients with urgent gastrointestinal (GI)-related complaints were preferentially seen in the office. Using control charts, we examined GI-related and all-diagnoses ED use over a 2-year period.



The rate of GI-related ED visits decreased by 60% after the intervention, from 4.89 to 1.95 per 1000 office visits (P < .001). Similarly, rates of GI-related ED visits during office hours decreased by 59% from 2.19 to 0.89 per 1000 (P < .001). Rates of all-diagnoses ED visits did not change.



Physician-level reporting of ED utilization to pediatric gastroenterologists was associated with physician engagement and a cultural and process change to preferentially treat patients with urgent issues in the office.
Departments of Emergency Medicine, Surgery, and Massachusetts General Physicians Organization, Boston, Massachusetts; and lee.jarone@mgh.harvard.edu.
Jarone
J
Lee
Massachusetts General Physicians Organization, Boston, Massachusetts; and MassGeneral Hospital for Children, Boston, Massachusetts.
Peter T
PT
Greenspan
MassGeneral Hospital for Children, Boston, Massachusetts.
Esther
E
Israel
MassGeneral Hospital for Children, Boston, Massachusetts.
Aubrey
A
Katz
MassGeneral Hospital for Children, Boston, Massachusetts.
Alessio
A
Fasano
Surgery, and.
Haytham M A
HM
Kaafarani
Massachusetts General Physicians Organization, Boston, Massachusetts; and.
Pamela L
PL
Linov
Departments of Emergency Medicine.
Ali S
AS
Raja
Massachusetts General Physicians Organization, Boston, Massachusetts; and Medicine, Massachusetts General Hospital, Boston, Massachusetts;
Sandhya K
SK
Rao
D000046:Academic Medical Centers / Q000458:organization & administration; D000293:Adolescent; D001900:Boston; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies