title: Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review.
abstract: Successful care transitions between emergency departments (EDs) and outpatient settings have implications for quality, safety, and cost of care.
  
  
  
  To investigate the effectiveness of ED-based care transition interventions in achieving outpatient follow-up among pediatric patients.
  
  
  
  Medline, Embase, CINAHL, Cochrane Library, trial registers, and reference lists of relevant articles.
  
  
  
  Eligible studies included randomized controlled trials of ED-based care transition interventions involving pediatric patients (aged ≤18 years). Study selection, data extraction, and risk of bias assessment were performed in duplicate and independent manner. Study results were pooled for meta-analysis by using a random effects model.
  
  
  
  Sixteen randomized controlled trials, comprising 3760 patients, were included in the study. Most interventions were single-site (n = 14), multicomponent (n = 12), and focused on patients with asthma (n = 8). Pooling data from 10 studies (n = 1965 patients) found moderate-quality evidence for a relative increase of 29% in outpatient follow-up with interventions compared with routine care (odds ratio, 1.58 [95% confidence interval, 1.08-2.31]). Successful interventions included structured telephone reminders, educational counseling on follow-up, and appointment scheduling assistance. There was low-quality evidence when pooling data from 5 studies (n = 1609 participants) that exhibited little or no beneficial effect of interventions on ED readmissions (risk ratio, 1.02 [95% confidence interval, 0.91-1.15]).
  
  
  
  All studies were conducted in urban US hospitals which makes generalization of the results to rural settings and other countries difficult.
  
  
  
  ED-based care transition interventions are effective in increasing follow-up but do not seem to reduce ED readmissions. Further research is required to investigate the mechanisms that affect the success of these interventions.
authors.affiliation: Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, abrahamj@uic.edu.
authors.forename: Joanna
authors.initials: J
authors.lastname: Abraham
authors.affiliation: Department of Family Medicine, and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kannampallil
authors.affiliation: Division of Academic Internal Medicine and Geriatrics, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Caskey
authors.affiliation: Department of Biomedical and Health Information Sciences, College of Applied Health Sciences.
authors.forename: Spyros
authors.initials: S
authors.lastname: Kitsiou
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D010360:Patient Transfer; D016032:Randomized Controlled Trials as Topic