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Appropriateness of Emergency Department Use in Pediatric Inflammatory Bowel Disease: A Quality Improvement Opportunity

Hoffenberg, Edward J.*; Park, K.T.; Dykes, Dana M.; Fridge, Jacqueline§; Kappelman, Michael D.||; Leibowitz, Ian H.; Tsou, V. Marc#; Colletti, Richard B.**

Journal of Pediatric Gastroenterology & Nutrition: September 2014 - Volume 59 - Issue 3 - p 324–326
doi: 10.1097/MPG.0000000000000457
Original Articles: Gastroenterology

Objectives: We sought to characterize emergency department (ED) encounters for pediatric inflammatory bowel disease (IBD) to identify areas for prevention.

Methods: Retrospective chart review of 5 consecutive ED encounters at 7 centers was performed.

Results: Of 35 unique encounters by 32 patients, 3 main factors contributed to ED utilization: disease severity or course, day or time of care, and physician instruction. Of the ED encounters, approximately one-fifth were judged medically unnecessary, and one-half avoidable in a more optimal health care system.

Conclusions: ED visits by pediatric patients with IBD may be reduced in a more optimal health care system.

*Digestive Health Institute, Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Medical Center, Cincinnati, Ohio

§Northwest Pediatric Gastroenterology LLC, Randall Children's Hospital, Portland, Oregon

||Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill

Children's Digestive Disease Program, Pediatric Digestive Diseases, Inova Fairfax Hospital for Children, Fairfax, Virginia

#Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Eastern Virginia Medical School, Children's Specialty Group, Norfolk

**University of Vermont College of Medicine, Burlington.

Address correspondence and reprint requests to Edward J. Hoffenberg, MD, Children's Hospital Colorado, Aurora, CO (e-mail: edward.hoffenberg@childrenscolorado.org).

Received 24 April, 2014

Accepted 5 June, 2014

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,