title: Pediatric Emergency Department Return: A Literature Review of Risk Factors and Interventions.
abstract: OBJECTIVE
  Children discharged from emergency departments (EDs) are often at risk for ED return. The objective was to identify risk factors and interventions to mitigate or prevent ED return among this patient population.
  
  
  METHODS
  Structured literature review of PubMed and clinicaltrials.gov was conducted to identify relevant studies. Inclusion criteria were studies evaluating ED returns by identifying risk factors and interventions in the pediatric population. Emergency department return was defined as returning to the ED within 1 year after initial visit. Abstract and full text articles were reviewed, and data were abstracted by 2 independent authors.
  
  
  RESULTS
  A total of 963 articles were screened and yielded 42 potential relevant articles involving pediatric population. After full text review, a total of 12 articles were included in the final analysis (6 on risk factors and 6 on interventions). Risk factors for pediatric ED return included behavioral/psychiatric problems, younger age, acuity of illness, medical history of asthma, and social factors. Interventions included computer-generated instructions, postdischarge telephone coaching, ED-made appointments, case management, and home environment intervention. Emergency department-made appointments and postdischarge telephone coaching plus monetary incentive improved outpatient follow-up rate but not ED return. Home environment assessment coupled with case management reduced ED returns specifically among asthma patients.
  
  
  CONCLUSIONS
  Several patient and visit characteristics can help predict children at risk for ED return. Although some interventions are successful at improving postdischarge follow-up, most did not reduce ED returns.
authors.affiliation: From the *Department of Emergency Medicine, Division of Critical Care, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; †Department of Emergency Medicine, Johns Hopkins University School of Medicine, and ‡Division of General Internal Medicine, Armstrong Institute for Patient Safety and Quality, Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins University School of Medicine, Baltimore, MD; §Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; ∥Department of Emergency Medicine, Johns Hopkins Health System; ¶Evidence-Based Practice Center, Johns Hopkins University; #Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; **Department of Emergency Medicine, Johns Hopkins University School of Medicine, ††Department of Applied Mathematics, Johns Hopkins University Whiting School of Engineering; ‡‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine; and §§Department of Emergency Medicine, Anesthesia Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Quincy Khoi
authors.initials: QK
authors.lastname: Tran
authors.forename: Jamil D
authors.initials: JD
authors.lastname: Bayram
authors.forename: Romsai T
authors.initials: RT
authors.lastname: Boonyasai
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Case
authors.forename: Christine
authors.initials: C
authors.lastname: Connor
authors.forename: David
authors.initials: D
authors.lastname: Doggett
authors.forename: Oluwakemi A
authors.initials: OA
authors.lastname: Fawole
authors.forename: O Mayowa
authors.initials: OM
authors.lastname: Ijagbemi
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
mesh_terms: D002986:Clinical Trials as Topic; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D010351:Patient Discharge; D000070316:Pediatric Emergency Medicine; D012307:Risk Factors