Education Cuts Repeat Fever Visits

ACEP News
June 2010

By Michele G. Sullivan
Elsevier Global Medical News


PHILADELPHIA -- Educating parents about fever in the emergency department may help reduce the number who bring their children back for another fever-related visit within 48 hours.

"Fever-specific discharge instructions decreased the 48-hour return rate significantly in our institution," Dr. Amy Dunn said at the annual meeting of the Eastern Society for Pediatric Research. "This seems to indicate that improved education about fever is helping parents manage these simple febrile illnesses at home."

"Fever phobia" is a common reason for parents to seek out emergency care, said Dr. Dunn, a pediatric emergency fellow at Connecticut Children's Medical Center, Hartford. "According to a recent survey by the Centers for Disease Control and Prevention, 15% of all pediatric emergency department visits are for fever--it is the most frequent reason for a pediatric ED visit," she said. A survey conducted in 2000 found that 21% of parents believe fever can cause brain damage and even death if left untreated, Dr. Dunn added.

Dr. Dunn and her colleagues wondered if educating parents about fever in children would help ease some of their concerns and reduce the ED recidivism rate.

"Our standard discharge instructions included just some general information about fever and when to come back to the emergency department, but nothing specific about fever or treating it," Dr. Dunn explained.

A multidisciplinary team developed a set of fever-specific discharge instructions that included more detailed information about the physiology of fever, as well as an age-specific dosing schedule for over-the-counter antipyretics.

The investigators conducted a 1-year retrospective case-control study to evaluate the form's impact on return rates after an ED admission for fever in children aged 8 weeks to 5 years.

The study included 202 children; the average patient age was 18 months. All of the patients were seen in the ED for a chief complaint of fever (average temperature 103° F).

Eighty-two of the children returned for another fever-related visit within 48 hours. Nine patients who returned (11%) were admitted to the hospital, indicating that most parents came back to the emergency department for reassurance rather than a true medical emergency, Dr. Dunn said.

The fever-specific discharge instructions were associated with a significantly better 48-hour return rate: 74% of those who did not return had received the instructions, compared with 53% of those who did return, a significant difference.

Providers who saw the children in the ED were supposed to fill out the age-specific antipyretic dosing schedule. Dr. Dunn saw a trend toward lower 48-hour return rates among patients when physicians completed those dosing information forms.

The parents of patients who did not return to the ED were more likely to have received discharge instructions with complete antipyretic dosing than were the parents of children who did return, Dr. Dunn explained.

Parents of 59% of patients who did not return to the ED had received complete instructions, whereas only 46% of patients who did return had received complete instructions.

Dr. Dunn and her coauthors had no financial disclosures.
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