Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections—cellulitis, pneumonia, and urinary tract infections.
We conducted a single-center retrospective cohort study of all visits made to the British Columbia Children's Hospital PED from May 1, 2012, to April 30, 2013. We identified scheduled RTEDs and characterized those associated with OPAT use with regard to their measures of PED utilization and clinical features.
Of 3904 RTED visits, 1310 (33.6%) were scheduled, of which 1029 were OPAT related. Among the latter, 749 RTEDs (69%) were for cellulitis, pneumonia, or urinary tract infections. The median length of stay for OPAT-related RTEDs was 2.0 hours. For 75 (24%) of 317 index visits and 213 (28%) of 749 subsequent RTEDs, oral antibiotic therapy would have been an appropriate option and OPAT could have been avoided.
Our findings suggest that OPAT poses a sizable burden on PED utilization, with a proportion of them potentially preventable.
From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Disclosure: The authors declare no conflict of interest. The following research was unfunded and there are no prior publications or submissions with any overlapping information, including studies and patients.
Reprints: Quynh Doan, MDCM, MHSc, PhD, Division of Emergency Medicine, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Office B429, 4480 Oak St, Vancouver, British Columbia V6H 3V4, Canada (e-mail: email@example.com).