Experts from Johns Hopkins Children’s Center participated in various sessions and presentations during the 2024 Pediatric Academic Societies Meeting. In this video, pediatric emergency medicine physician Mary Beth Howard discusses her research on characteristics of infant emergency department utilization in a health care system. The goal of this study was to compare patterns of emergency department use for children less than 1 year of age by visit frequency and research utilization.
Hello, my name is Mary Beth Howard and I am an assistant professor of pediatrics in the Johns Hopkins Children's Center and a pediatric emergency medicine physician. I'm excited to share with you today. A study that we presented at the pediatric academic society meeting entitled Characteristics of Infant emergency department, utilization in a health care system. It is well established in the literature that frequent utilize of the emergency department make up a substantial share of overall emergency department use. Frequent utilizes of the emergency department have become a target for quality improvement care and patient care initiatives. With the goal of improving care delivered while limiting inefficient health care spending within the pediatric population. There is notable variation in emergency department use by age younger age has been consistently identified as a risk factor for frequent and recurrent emergency department use infants or Children less than one year of age without chronic conditions are most likely to make up recurrent low acuity and low utilization emergency department visits across pediatrics. Those under one year of age have unique health and developmental needs. These include increased risk of serious bacterial infection during the first three months of life or increased risk of decompensation from gastrointestinal and respiratory illnesses which are routine pediatric complaints but may present more subtly or more acutely in infants. Their limited ability to communicate and indirect signs of illness may also contribute to heightened parental and provider concern. As a result, a better understanding of health service needs of infants who visit the emergency department may help inform targeted interventions to decrease unnecessary emergency department use and improve health care delivered to Children in their first year of life. So the goal of this study was to compare patterns of emergency department use for Children less than one year of age by visit, frequency and resource utilization to do this. We performed a retrospective cohort study of infants less than one year of age presenting to one of five emergency departments in the Johns Hopkins health care system. Over a five year period, we counted the number of repeat emergency department visits over the subsequent one year period after the index visit and then totaled the number of visits for each in infant over this one year. Follow up patient characteristics such as age, sex, race, ethnicity and the presence of a chronic condition were analyzed. We also analyze visit characteristics such as arrival, day and time visit acuity level and whether the patient was admitted or discharged as well as any testing and interventions during their emergency department visit across over 20,000 infants with over 30,000 visits during the study time frame. A third had more than one visit in a year. Across all visits, over half were low acuity and over 80% of patients were discharged. The most common diagnoses were respiratory disease, fever and viral illnesses and gastrointestinal diseases. These visit features remain constant despite increasing number of visits. And as the e emergency department visit frequency increased, there was an increase in the percentage of Children who were older. Non-hispanic black and triage is low acuity and the infants with greater than four emergency department visits. During the study time frame, they were found to be more likely to be without a chronic condition, have no medications or testing ordered and to be discharged from the emergency department. Overall, we concluded that there was a disproportionate share of emergency department utilization for those with repeat visits without chronic conditions who are least likely to need medication testing and hospital admission. This description of patterns of emergency department use in the infant population will be helpful to develop interventions to reduce frequent emergency department use in this known high emergency department utilization utilizing population. Next steps include understanding the motivators to repeat emergency department visits in this population. And if it is found that they are due to the need for education or convenience, improving the access to outpatient healthcare venues needed by infants. I would like to thank my mentors who helped with this study. Doctors Kemi Bakki and Tish Ryan, as well as the Precision Medicine Analytics. Platform at the Johns Hopkins Institute for Clinical and translational Research from which this da data for the study was extracted. Thank you.
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