Factors Associated with Pediatric Emergency Room Utilization in an Urban Community Hospital in Santiago, Dominican Republic

Abstract

Background: In low resource settings, maximizing effective use of emergency room (ER) services is imperative. This problem is anecdotally observed in the public hospital setting in Santiago, Dominican Republic (DR). There are no studies presently published examining ER use in this pediatric population or reasons caregivers choose to utilize the pediatric ER. Financial and systemic limitations have been previously cited as important contributors to the high pediatric mortality rate in the DR. Methods: In this cross-sectional, descriptive study, a survey was administered to 117 caregivers (e.g. mother, father) of children in the ER at Hospital Especializado Juan XXIII over an eight-week period. Survey questions included perceived urgency of illness, education level, monthly income, and frequency of ER visits in the last six months. We defined frequent ER visits as greater than four visits within the last six months, low income as below 10,000 pesos/month, and low education as having no high school education. Logistic regression was used to assess significant associations between variables. Results: Caregivers in the pediatric ER were predominantly female (94%) with a mean age of 30 ± 11 years. 72% of respondents reported the child’s problem as “extremely urgent,” while 82% of the children were triaged as non-urgent. Children of caregivers with any high school education had 69% lower odds of having 4 or more ED visits in the last 6 months (OR, 0.31; 95% CI, 0.13–0.75; p = 0.009), compared to children of caregivers with no high school education, after adjusting for the income category of the caregiver. Conclusions: Perceived urgency of pediatric medical problems may contribute to increased use of the ER for non-urgent medical problems. Low education level is associated with increased pediatric ER use over a six-month period. Assessing utilization of pediatric ERs in the public health care system in Santiago could provide a framework for the design of targeted educational and systemic changes, supporting the ultimate goal of providing the best possible care for pediatric patients in low-resource settings.

The Role of Patient and Parent Education in Pediatric Cast Complications

“…Patient education materials certainly cannot prevent application issues on the provider/ortho tech's end; however, these educational materials can and should be inclusive of signs and symptoms of underlying skin issues such as pressure ulcers and be emphatic about contacting the clinic immediately upon the caregiver's suspicion of such. It is prudent to consider parental/caregiver perceptions when providing any education; ED visits, RTC, treatment compliance, and trust in providers have all been attributed to the perceived urgency of illness by the caretaker (Lockwood et al, 2019; Sofu et al, 2015). Our website did advise caregivers to contact the clinic if their child were to experience an area of pain/burning inside the cast, as this is a symptom of potential pressure ulcer; however, all of the skin issues in the postintervention group were reported or discovered at follow-up.…”

Characterization of attendance in a pediatric emergency care service / Caracterização dos atendimentos em um serviço de pronto-atendimento pediátrico

“…[15][16] This data reiterates that the notion of urgency of parents and guardians is different from the real complexity of the symptomatology. 7 The search for emergency services by most parents because of fever -one of the most common symptoms in childhoodserves as a parameter to determine the severity of the child's illness. Thus, fever becomes the main symptom for which parents seek emergency services, even in unnecessary cases.…”

“…The high demand of children for pediatric emergency services interferes with the quality of care; patients who really need agility in care wait for hours with those who demand primary care and orientation. 6 A study 7 showed that the perception of the children's caregivers does not match the real need for emergency care services, when 72% of the caregivers identified the problem that brought them to the unit as extremely urgent; however, 82% of the children were later classified as non-urgent. This discrepancy may, according to the study, be related to the caregivers' low educational level.…”