Pagers Combined With Telephones Improve Successful Follow-up From a Pediatric Emergency Department In K. Kim, MD*; Karen A. Lanni, MD*; Edgar Collazo, MD*; Ed J. Gracely, PhD§; and Robert Belfer, MD‡ ABSTRACT. Objective. To determine whether there is a significant difference in initial successful contact when attempting follow-up of patients discharged from a pediatric emergency department (ED) using either pagers or the telephone. In addition, to evaluate whether the combination of both pager and telephone follow-up is more successful than telephone follow-up alone when confined to a 2-hour period. Design and Setting. A prospective comparison of in- tervention and control groups taken from convenience samples of patients seen in an ED of an urban, tertiary care children’s hospital. Participants. One hundred eighty-five patients whose families had access to both a pager and a telephone (intervention group) and 112 patients whose families had access to only a telephone (control group) were enrolled. Intervention. Before discharging the patient from the ED, the investigators verified a pager number and/or a best contact telephone number for a follow-up telephone call. Participants were divided into 2 groups. The inter- vention group consisted of caretakers with both pagers and telephones. The control group consisted of caretak- ers with only telephones. On even calendar days after ED visits, intervention group caretakers were paged initially from 11:00 AM to 11:59 AM. On odd calendar days, inter- vention group caretakers were telephoned initially from 11:00 AM to 11:59 AM. Successful contact was defined as communication with a family member or guardian over the age of 18. If the caretaker spoke only Spanish, a translator was used. In a crossover design with the inter- vention group, if contact was unsuccessful after 1 hour, the alternative mode of communication was used at noon. Control group caretakers were telephoned from 11:00 AM to 11:59 AM. If telephone contact was unsuccess- ful, they were called again 1 hour later. Results. Two hundred forty-six (36%) of 685 of the convenience sample of caretakers had access to both a pager and a telephone. Fifty-two (55%) of 94 intervention caretakers were contacted initially using pagers versus 47 (52%) of 91 intervention caretakers contacted initially by telephones. Overall successful contact of intervention caretakers (telephones and pagers) was 145 (78%) of 185 when confined to a 2-hour time period. In contrast, over- all successful contact of control caretakers was 68 (61%) of 112 when confined to a 2-hour time period. Successful contact was greater with the intervention caretakers than with control caretakers (78% vs 61%). Conclusions. No significant difference in successful contact was seen whether paged or telephoned initially. The combination of both pagers and telephone follow-up was more successful than telephone follow-up alone when confined between 11:00 AM to 1:00 PM. Pediatrics 2002;110(1). URL: http://www.pediatrics.org/cgi/content/ full/110/1/e1; follow-up, pediatric emergency department, pagers, telephones. ABREVIATION. ED, emergency department. M edical use of pagers preceded the public’s use of pagers for business and social uses. The rapid expansion of cellular communi- cation services in the 1990s led to nonmedical per- sonnel using pagers. The inexpensive price for pager use (national monthly cost of $8.90) has contributed to the deep market penetration of pagers to all so- cioeconomic levels. In 1998, 22 million US house- holds of the estimated 100 million US households used pagers. Demographic data demonstrates that pager ownership is highest among urban “young parents” and “middle-aged parents.” 1 Most impor- tantly, this data highlights the increasing use of pag- ers by households with children. Unsuccessful telephone follow-up from pediatric emergency departments (EDs) is a common problem. Despite multiple phone calls at numerous times of the day for several days, the unreliability of tele- phone follow-up in patients discharged from an ED has been well described in both pediatric and adult populations. 2–4 Often, patients or their caretakers provide disconnected telephone numbers, incorrect telephone numbers, or telephone numbers where they can not be reached. Also, these studies illustrate the laborious and time-consuming process of tele- phone follow-up. Successful telephone follow-up has been shown to improve care of ED-treated patients. It increases pa- tient satisfaction with the care received and increases compliance with discharge instructions. 5–8 In addi- tion, assurance of follow-up may allow an ED phy- sician a broader selection of choices regarding dis- position from the ED. For example, previous studies suggesting outpatient management of febrile young infants and febrile children with sickle cell disease rely heavily on successful follow-up. 9 –12 Efficient telephone follow-up has become highly desirable, From the Departments of *Pediatrics and ‡Emergency Medicine, St Chris- topher’s Hospital for Children. Philadelphia, Pennsylvania; and §Depart- ment of Community and Preventive Medicine, Medical College of Pennsyl- vania, Hahnemann School of Medicine, Philadelphia, Pennsylvania. Abstract presented at the annual meeting of the American Academy of Pediatrics, Section of Emergency Medicine, San Francisco, CA, October 16, 1998. Received for publication Apr 19, 2001; accepted Jan 22, 2002. Reprint requests to (I.K.K.) Department of Pediatrics, Division of Emer- gency Medicine, 3705 Fifth Ave, Children’s Hospital of Pittsburgh, Pitts- burgh, Pennsylvania, 15213-2583. E-mail: PEDIATRICS (ISSN 0031 4005). Copyright © 2002 by the American Acad- emy of Pediatrics. http://www.pediatrics.org/cgi/content/full/110/1/e1 PEDIATRICS Vol. 110 No. 1 July 2002 1 of 5 by guest on April 8, 2017 Downloaded from