A Profile of Nonurgent Emergency Department Use in an Urban Pediatric Hospital

Abstract

Objectives This study was designed to develop a descriptive profile of parents and caregivers who bring their children to the emergency department for non-urgent issues as well as exploring the reasons for presenting to an urban hospital pediatric emergency department for non-urgent conditions. Such work is necessary in order to develop effective interventions. Methods A total of 106 parents/caregivers whose child was triaged with a non-emergent/urgent condition completed a 15–20 minute computerized survey (English and Spanish) in an urban pediatric emergency department. Results The majority of respondents described themselves as Latino (76%) and foreign-born (62%). About half (49%) reported having an annual income of less than $20,000 and 43% of respondents did not have health insurance for themselves. Almost all (95%) of the index children had a primary care physician and health insurance. In spite of being triaged as non-urgent, over half (63%) described their child’s condition as “very” or “extremely” urgent. About half of the respondents reported not receiving basic information on childhood illnesses from their child’s doctor. Reasons for non-urgent visits seemed to revolve around issues of convenience and perception of quality of care. Conclusions Interventions should focus on health literacy and ensure that parents are provided relevant and accurate education on pediatric illnesses and common safety concerns; by increasing parental education on pediatric health, parents may be better able to assess acuity of their child’s health issues.

Non-urgent pediatric emergency department utilization - A case review

“…Common knowledge dictates that ED care is costlier than care by a PCP and is less effective in providing appropriate primary and chronic condition care for children. A key set of principles guiding this discussion relates to child health education provided to parents, convenience to reach care when needed, and trust and confidence in medical providers [2] . ED providers can assist in directing these patients to primary care…”

“…If the parent's call is made after 1400, the likelihood of advising to go to an ED was even higher [10] . Additionally, parents perceive inconvenience relating to PCP hours of availability, location, and needed transportation [2] . Another reason that parents go to the ED for care is that they are unable to determine whether the condition was emergent or not.…”

“…Most adult ED providers are uninformed of the extent of inappropriate ED use by the pediatric population, so merely contribute to the misuse by acquiescing to rapid discharge of the non-urgent pediatric patient. In a study by Kubicek et al, it was articulated that parents and primary care providers serve as "gatekeepers" to medical care for children [2] . Therefore, interventions designed for these primary caretakers' must consider the distinctiveness of all involved.…”

L’éthique dans les services d’accueil des urgences pédiatriques : accès aux soins, communication et confidentialité

“…De plus, le pédiatre doit faire face au stress parental. Il a été montré que 63 % des parents consultant dans les SAU pour un motif non urgent pensaient que la situation relevait d'une « très grande » ou « extrême » urgence [21]. Ce ressenti d'anxiété est difficile à apprécier.…”

Decreasing Low Acuity Pediatric Emergency Room Visits with Increased Clinic Access and Improved Parent Education

“…Parental education has also been shown to be a determining factor for medical decision making 9 . One solution to the parental education barrier from a 2011 Texas A&M University study gave parents handbooks that discussed common pediatric illnesses.…”