A pediatric emergency department follow-up system: Completing the cycle of care

Background. Prior to 1993, the follow-up program for our pediatric emergency department (ED) was the responsibility of the rotating senior pediatric resident. There were inherent problems with this system, as a consequence of inconsistent personnel. The residents' revolving schedules and the fact that they were accountable to other clinical areas decreased their availability for follow-up. Also, it was difficult for the clerical staff to identify the person responsible for answering parent calls. The medical director of the ED made the decision to turn the core responsibility for the follow-up program to the nurse practitioners in addition to their direct care provider role. The nurse practitioner group is a consistent member of the treatment team who has the critical thinking skills necessary to handle the majority of issues that require follow-up. The emergency attending physicians are available for consultation whenever questions arise. Objective: Review of current follow-up program of a pediatric ED and its impact on patient care, patient/parent satisfaction, and communication with community providers and specialists. Method: A retrospective review of the evolution of the multifaceted follow-up of patients from an urban pediatric ED. Results: Antidotal evidence suggests that a comprehensive follow-up program increases patient satisfaction, improves communication between the ED, primary care providers, and specialists. It also decreases the workload of the attending emergency physicians, allowing them more time to focus on acute issues. In addition, the follow-up program for ED patients can decrease the medical /legal risks associated with reporting of delayed laboratory results. Conclusion: The next step in further reviewing this program is the development of a satisfaction questionnaire for patient/ families and community providers to quantify their level of satisfaction with the program. A retrospective chart review of the patients who received a follow-up phone call after discharge, and the return visit rate would be another avenue to pursue to validate our antidotal information.