Q&A: Tips for pediatric emergency department case managers
Q: What does a pediatric emergency department (ED) case manager have to consider that a case manager in an adult ED does not?
A: Common symptoms seen in a pediatric ED are unique from adult EDs. There are some differences between boys and girls, but the common presenting symptoms for ED visits are similar to the common symptoms seen and treated in primary care medical homes. This further fuels the focus on pediatric EDs to reduce and divert patients presenting with nonemergency diagnoses.
The pediatric ED case manager does many of the same interventions as an adult ED case manager, but there are a few differences. Ensuring the patient has a good fit with their primary care medical home for routine well-child checkups as well as illness care is essential. The pediatric ED case manager should know about all the pediatric primary care medical homes in their community, including their hours of operations, nurse call numbers, locations, language capabilities, and after-hours coverage or urgent care affiliations (Walsh & Zander, 2014).
Identifying disease-specific services and population health programs to meet the patient’s needs will provide the patient and family with added support for better parent management and/or self-management. Population health programs in pediatrics can be variable, but most payers and pediatric hospitals have programs for asthma. Depending on the local community, there may also be population health programs for sickle cell disease, complex chronic conditions, seizures, and obesity. In addition to specific programs, there are many services available through subspecialty providers for conditions such as migraines, chronic pain, POTS, and ADHD. The pediatric ED case manager needs to leverage available clinic-based services and population health programs to best meet the patient’s and family’s needs (Walsh & Zander, 2014).
Linking patients to medical homes, population health programs, and subspecialty providers will do no good if there are other barriers to accessing healthcare services. Transportation is a frequent barrier for families, but most Medicaid programs have provisions for nonemergency medical transports. Unfortunately, these transport programs are not easy to access either and often require both preplanning and documentation. If there are multiple follow-up appointments, the coordination of both the transport and the appointments can be too much for the family. The other common barrier in pediatrics is the prior authorization requirements for routine medications to treat pediatric illnesses and chronic diseases like asthma and ADHD. Specialty formulas can be expensive and unavailable at local pharmacies (who need to special order the formula). WIC programs will provide specialty formulas to eligible infants with a physician’s prescription, but it may take time for the WIC program to receive the formula. Comprehensively addressing the barriers to fulfilling the care plan will enable the family to keep from returning to the ED (Walsh & Zander, 2014).
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