378 - Characteristics of Infant Emergency Department Utilization in a Healthcare System

Poster Number: 378
Publication Number: 378.333

Background: Frequent utilizers of emergency departments (ED) make up a substantial share of overall ED use. Within the pediatric ED setting, infants (age 0-12 months) comprise a disproportionate share of pediatric ED visits.

Objective: The objective was to compare patterns of ED use for children less than 12 months of age by visit frequency and resource utilization.

Design/Methods: This is a retrospective cohort study of infants less than 12 months presenting to 5 EDs in one health system over a 5-year period, with a 365-day follow-up after each index visit. Patient characteristics (age, sex, race/ethnicity, presence of chronic condition) and visit characteristics (arrival day/time, acuity level, disposition, testing [labs and radiographs, medications]) were assessed. The relationship between patient and visit characteristics with utilization and repeat visits was assessed using multivariable regression.

Results: A total of 20,620 infant patients had 33,127 ED visits during the study timeframe. Thirty three percent (n=6842) had more than one visit in a year; 3964 (19.2%) had two visits, 1542 (7.5%) had three visits, and 1336 (6.5%) had 4 or more visits. Across all visits, over half (52%) were low acuity, with emergency severity index 4 or 5. The most common diagnoses were respiratory diseases (27%), systemic states (including fever, viral illness, 23%), and gastrointestinal diseases (15%). These diagnoses remained the most common for those with 1, 2, 3, and ≥ 4 ED visits. As ED visit frequency increased, there was an increase in percentage of children who were non-Hispanic Black (OR 3.8, 95% CI 3.7-3.9), and triaged as low acuity (OR 3.1, 95% CI 3.0-3.2). Infants with ≥4 ED visits were more likely to be without a chronic condition (OR 2.8 95% CI 2.5-2.9), have no medications or testing ordered (OR 2.4, 95% CI 2.0-2.5), and be discharged (OR 3.0, 95% CI 2.8-3.1).

Conclusion(s): Risk factors for recurrent ED use by infants include age, race/ethnicity, and low acuity visit status. There was a disproportionate share of ED utilization for those with repeat visits without chronic conditions who were least likely to need medications, testing, and hospital admission. With increasing attention paid to high-utilizing patients within the healthcare system, EDs may find it valuable to assess why infants use the ED at high frequencies and develop care integration systems to improve high value care, including preventive care, while decreasing resource burden.