Impact of a Pediatric Dermatology Service on Emergency Department Utilization for Children with Dermatitis.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic pediatric skin disease, and it can profoundly affect a family's quality of life. Children with flaring AD often seek treatment in emergency departments (EDs), which leads to expensive care and ineffective long-term disease control. OBJECTIVES: The objective of the current study was to determine the effect of a pediatric dermatology service (PDS) on ED use and charges and of disease outcomes for patients diagnosed with AD before and after establishing an intramural PDS. METHODS: This retrospective study reviewed electronic medical records of patients presenting to an urban children's hospital ED with diagnoses encompassing the terms AD, eczema, dermatitis and International Classification of Diseases, Ninth Revision (ICD-9) codes 691.8 and 692.9 during the year before (pre-PDS period) and 3 years after establishing a PDS. RESULTS: There were 205 ED visits for dermatitis in the pre-PDS period and 130 in the with-PDS period, a 36.6% decrease (p < 0.001). In the pre-PDS period, 53.7% (n = 110/205) of patients presenting to the ED had moderate dermatitis, compared with 26.2% (n = 34/130) in the with-PDS period, a 69.1% decrease (p < 0.001). Total ED charges were $142,885 for the pre-PDS period and $90,610 for the with-PDS period, a $52,275 decrease. CONCLUSIONS: This study provides a salient example of achieving the triple aim of health care reform: improving health outcomes (decreased ED visits) improving the patient experience (transitioning care from the ED to the more appropriate ambulatory clinical setting), and decreasing the cost of care (decreased ED charges).

Evaluation of a high-dose continuous albuterol protocol for treatment of pediatric asthma in the emergency department.

OBJECTIVES: This study aimed to assess the safety and efficacy of a high-dose continuous nebulized albuterol (CNA) protocol for treatment of asthma in the pediatric emergency department (ED). A secondary objective included a cost-benefit analysis of protocol use. METHODS: In this retrospective chart review, we compared cohorts of patients treated in our ED for acute asthma exacerbation before and after implementation of a CNA protocol. Patients between the ages of 2 and 21 years seen between March 1 and May 31, 2008 (preprotocol, n = 393), and March 1 to May 31, 2009 (postprotocol, n = 373), were included. Safety data included medication-related adverse effects as well as serum potassium and glucose levels. Efficacy data included ED length of stay, disposition, return visits, time to first albuterol treatment, and corticosteroid administration. Cost analysis included the cost of medications and respiratory therapy time. RESULTS: Postprotocol patients more often received CNA (57.9% vs 25.2%, P < 0.01). No significant adverse effects, including tachyarrhythmia and symptomatic hypokalemia, were found in either group. Serum potassium levels were higher in the postprotocol group (3.9 mEq/L [n = 34] vs 3.5 mEq/L [n = 28], P < 0.01). Emergency department stay was longer in the postprotocol group (217.8 minutes vs 187.2 minutes, P < 0.01). Emergency department disposition was similar in both groups. The mean cost per patient was higher in the postprotocol group ($327.21 vs $277.95, P < 0.01). CONCLUSIONS: We found the CNA protocol to be safe. Superior efficacy to a traditional treatment approach was not demonstrated. The mean cost of treatment was higher in the postprotocol group. Further prospective studies should be conducted to confirm the findings of this retrospective, observational study.