Analysis of reconsultations in a pediatric emergency service

Abstract

Reconsultations are an indicator of the quality of care. Learning about their characteristics allows planning strategies for continuous quality of care improvement.

Objective:

To describe the characteristics of reconsultations within the first 72 hours in a Pediatric Emergency (PE) service during January, April, July and October of 2017.

Methods:

Descriptive, retrospective study through the review of electronic medical records of the PE service of a private health care provider in Montevideo. Variables: frequency, age, sex, time, reason for consultation and evolution.

Results:

During the time analyzed, there were 8299 visits and 476 reconsultations. 54 reconsultations were excluded because they were due to conditions other than the one in the initial visit. 422 were included in the study, representing 5.1%. Median age was 4 years. Reasons for reconsultations: persistence of symptoms 204 (48%), disease evolution 73 (17%), control 59 (14%), tests pending 51 (12%), worsening 30 (7%), a different diagnosis 5 (14%). After the second visit 88% were discharged to their homes and 11.5% were admitted. No child was referred to the intensive care unit, and none of them died.

Conclusions:

The rate of reconsultations in this service is similar to that reported in other series. Upon analyzing the reason for reconsultations, it is necessary to improve clinical management, developing communication strategies with parents and carers and strengthening outpatient visits and counter-referral to the first level of care. It is important to repeat the study after the implementation of plans to improve clinical management.