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Impact of a Pediatric Dermatology Service on Emergency Department Utilization for Children with Dermatitis
Author(s) -
Beal Brandon T.,
Prodanovic Edward,
Kuo Jimmy E.,
Armbrecht Eric S.,
Peter John R.,
Siegfried Elaine C.
Publication year - 2015
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12688
Subject(s) - medicine , atopic dermatitis , emergency department , medical record , retrospective cohort study , disease , dermatology , incidence (geometry) , pediatrics , surgery , physics , psychiatry , optics
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 ( ED s), 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).