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Fever kit helps ED save $300,000 in three years
Unnecessary return visits cut nearly in half
By creating inexpensive fever kits and providing them free of charge to parents of children between 3 months and 5 years of age who presented and were discharged, the ED at Presbyterian Hospital of Dallas has saved approximately $300,000 since the initial pilot program began in July 2004. In addition, notes Mary Rowe, RN, MSN, CEN, nurse manager of the ED, the staff saw a 42% drop in inappropriate fever return visits to the ED between July 2004 and December 2004.
Before the fever kit project was initiated in 2004, 53% of parents of pediatric patients with fever had made no attempt at fever control prior to presenting to the ED, Rowe says. The percentage of parents of febrile children who made no attempt at fever control prior to presenting to the ED dropped to 11% in 2005. "These levels have stayed about the same," she reports.
"The staff were reporting a large number of bounce-backs [return visits], so we brainstormed about what we could do to educate the public," Rowe recalls. At Presbyterian, an inappropriate repeat visit for fever involves patients previously treated within 72 hours for a minor bacterial illness such as otitis media and/ or upper respiratory infections.
Rowe and her staff came up with the format for the kits, which include a digital thermometer, a supply of children's acetaminophen, an oral syringe to measure doses, and dosing instructions in English and Spanish. When a young patient with a fever enters triage, vitals and temperature are taken. If they are febrile, they are treated in triage for fever. "Then, based on their acuity rating, they either go to fast track or the main ED," says Rowe.
Education is delivered at discharge, says Linda Miars, LVN, who works in fast track and who helped implement the program. "We make sure they have a thermometer at home to measure the child's temperature, and if they come in with fever but were not treated by their parent, we treat the fever with Motrin or Tylenol and recheck upon discharge," she says. The staff members also demonstrate how to take the child's temperature, Miars says. "They do not just walk out with a piece of equipment they don't know how to work."
The staff also discuss proper dosage, based on weight, and how parents should alternate acetaminophen and ibuprofen. "I often draw a clock and show them when to give each medicine," she notes. If the parents do not speak English at all, a telephone interpreter is available. In addition, bilingual fever care instructions are provided on laminated reference cards.
Parents who don't speak English present a special challenge, says Miars. "They think fever is a sickness, as opposed to a symptom, so when they come in and say the child had a fever yesterday, they gave the child Motrin, and it came back, it's a challenge to explain the difference to them," she says. The parents do not want to appear to be uneducated or unable to take care of their kids, Miars says. They greatly appreciate the bilingual cards, says Miars, noting, "I tell them to put it on the fridge."
Calculating the savings
According to Rowe, most of the families who come in for inappropriate repeat febrile illness are uninsured and depart from the ED with an average bill of about $350 ($300 when the program began), which they cannot afford to pay. Each kit costs $2.21 to put together, and the cost is paid by the hospital's community outreach center. For the first six months, 327 kits were given out. Rowe estimated that cost savings for the hospital, in terms of care that wouldn't be reimbursed, was $54,732, which equates to a little more than $100,000 per year. Rowe asserts the savings have continued at that pace each year.
Rowe has had no problem keeping the program alive. "It has just become part of our culture," she says. Any ED could do what she has done, Rowe says. "Even if they had to pay for it themselves, it would be worth it," she says.
Miars expresses her admiration for the program. "If anything, it's not used enough," she says. "I'd like to see it used by every nurse at every opportunity — not just in fast track."
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