For children leaving the emergency department before being seen by a physician, counseling from nurses decreases return visits

BackgroundNurses counsel the parents of patients leaving without being seen by a physician (LWBS) about common childhood illnesses. This strategy’s impact is not known.ObjectiveTo assess the impact of nurse counseling on ED return visits and outcomes for children who LWBS.MethodsThis retrospective cohort study used the computerized database of a tertiary care pediatric ED. Participants were all triaged children who LWBS between April 1st 2008 and March 31st 2009. Parents who notified nurses of their intention to leave received information and counseling on when to return. This counseling’s occurence was this study’s exposure of interest. The control group included patients who LWBS without notification and thus were not counseled. The primary outcome was a return visit to the ED within 48 h. Triage level and referral status were used as severity indicators. To demonstrate a 2% difference in return visits (α value 0.05, power 80%), 3213 participants were needed per group.ResultsDuring the study period, 60,525 patients consulted the ED and 10,323 LWBS; of these, 4639 (45%) received nurse counseling and 5684 (65%) did not. There was a 2.0% (95% CI 1.0, 3.0) decrease in ED return visit proportions between groups. On multiple logistic regression, the counseled group was less likely to return to the ED within 48 h.ConclusionThis study suggests that, of patients who LWBS, those who receive counseling by a nurse have less return visits in the following 48 h.