Evaluation of compliance with early postbirth follow-up and unnecessary visits to the paediatric emergency department: a prospective observational study at the Lenval Children's Hospital in Nice

Antoine Tran, Anne-Laure Hérissé, Marion Isoardo, Petri Valo, Anne-Marie Maillotte, Hervé Haas, Dominique Donzeau, Emma Freyssinet, Christian Pradier, Stéphanie Gentile, Antoine Tran, Anne-Laure Hérissé, Marion Isoardo, Petri Valo, Anne-Marie Maillotte, Hervé Haas, Dominique Donzeau, Emma Freyssinet, Christian Pradier, Stéphanie Gentile

Abstract

Objective: To evaluate compliance with the French National Authority for Health's (Haute Autorité de Santé, HAS) postbirth follow-up recommendations for newborns attending our paediatric emergency department (PED) and identify risk factors associated with non-compliance and unnecessary emergency department utilisation.

Design: Prospective, single centre.

Setting: Fourth biggest PED in France in terms of attendance (CHU-Lenval).

Patients: 280 patients of whom 249 were included in the statistical analysis.

Main outcome measures: The primary outcome of this study was the evaluation of compliance of the care pathway for newborns consulting at the PED with respect to the French postbirth follow-up recommendations. Secondary outcome was the assessment of whether the visit to the PED was justified by means of PED reception software and two postconsultation interviews RESULTS: 77.5% (193) of the newborns had non-compliant care pathways and 43% (107) of PED visits were unnecessary. Risk factors associated with a non-compliance regarding the HAS's postbirth follow-up recommendations were: unnecessary visit to the PED (OR 2.0, 95% CI 1.1 to 3.9), precariousness (OR 2.8, 95% CI 1.4 to 6.2), birth in a public maternity hospital (OR 2.5, 95% CI 1.3 to 4.8) and no information about HAS's postbirth follow-up recommendations on discharge from maternity ward (OR 11.4, 95% CI 5.8 to 23.3). Risk factors for unnecessary PED visits were: non-compliant care pathway (OR 2.0, 95% CI 1.1 to 3.9) and a first medical visit at a PED (OR 1.8, 95% CI 1.1 to 3.1).

Conclusion: Postbirth follow-up may lead to decrease unnecessary emergency department visits unnecessary emergency department visits.

Trial registration number: The study bears the clinical trial number NCT02863627.

Keywords: organisation of health services; paediatric A&E and ambulatory care; perinatology; primary care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Patient flow chart. a The reasons why eligible children were not included were probably related to workload and the organisation of medical and paramedical teams. PED, paediatric emergency department.

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