Frequent users in paediatric emergency departments. Who are they? Why do they consult?

García, Arístides Rivas; Martín, Gema Manrique; Laiseca, Laura Butragueño; García, Sofía Mesa; A, Segura; Iglesia, Vanessa Fernández; Sánchez, Raúl; Mulet, Juan Mariano Aguilar

doi:10.1016/j.anpede.2016.03.010

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…Higher prevalence of medical rather than trauma causes for frequent use mirrors that of adult frequent EMS1 and ED users,44 suggesting that there are commonalities between population groups. It can be hypothesised that interventions developed for those other populations and have demonstrated some effectiveness7 45 might be suitable for adaptation for paediatric frequent users.…”

Section: Discussionmentioning

confidence: 99%

Paediatric frequent use of emergency medical services: a systematic review

et al. 2022

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BackgroundFrequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS.MethodsFour electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis.ResultsThe search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use.ConclusionThe broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.

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Section: Discussionmentioning

confidence: 99%

Paediatric frequent use of emergency medical services: a systematic review

et al. 2022

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“…8 A idade parece ser um fator importante e que condiciona um maior número de admissões. García et al mostraram que 88% dos utilizadores frequentes tinham uma idade igual ou inferior a três anos, 18 resultado sobreponível ao nosso. Seguin et al demonstraram haver uma associação entre a idade mais jovem e a utilização recorrente da UP, com um maior número de admissões até aos três anos e uma redução importante desse número posteriormente, a partir da idade escolar.…”

Section: Discussão Conhecer Os Utilizadores Frequentesunclassified

Utilizadores Frequentes da Urgência Pediátrica: Conhecer, Intervir e Analisar - Um Estudo Piloto

et al. 2020

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Introduction: Frequent users contribute to an excessive volume of admissions in the emergency department, impairing the quality of healthcare services. The aim of this study was to identify and characterize the population of frequent users of the pediatric emergencydepartment, establish an individual plan of intervention and evaluate its efficacy.Material and Methods: Intervention study including children and adolescents younger than 16 years, with more than 10 visits in a year to an emergency department of a secondary care hospital. An intervention program was created with a multidisciplinary team and a case manager, who was responsible for the execution of the individual plan of intervention. One year later, the number of visits after the intervention was assessed.Results: We identified 90 patients with a frequent user profile, with 1182 visits. Only 17.3% of the visits had a previous referral. Most of the visits were considered non urgent/less urgent (59%). The intervention included 82 children/adolescents. One year later, there was a significant reduction in the number of visits: median reduction of 62% in 78 participants.Discussion: Most of the visits by frequent users were considered non urgent/less urgent, reflecting a clinically unjustified use of the emergency department. The intervention seems to be effective as the number of visits decreased.Conclusion: This population of frequent users seems to be a heterogeneous group with different problems and levels of complexity. A multidisciplinary and individual intervention, with a case manager, might contribute to reduce the excessive use of the emergency department and improve the provision of health care services to these children.

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“…Similarly, in the international context, there is a paucity of research including psychological variables as influential factors in NUPs (Alele et al., 2019; Pol et al., 2023). On the one hand, previous research in Spain has mainly focused on patients who are frequent or hyperfrequent users of PEDs (Expósito‐Ruiz et al., 2017; Montoro‐Pérez, Montejano‐Lozoya, Escribano et al., 2023; Rivas et al., 2017). On the other, evidence on the role of psychological factors in NUPs is based on qualitative research (Butun et al., 2022; Butun & Hemingway, 2018; Canévet et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with non‐urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross‐sectional descriptive study

Montoro‐Pérez,

Montejano‐Lozoya,

Escribano

et al. 2024

Journal of Clinical Nursing

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ObjectivesTo explore the rate of NUPs and associated factors in the PED of the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain) using Andersen's Behavioural Model.MethodsWe conducted a descriptive cross‐sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the ‘Hospital Universitario y Politécnico La Fe’ in Valencia (Spain).ResultsThe study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first‐time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031).ConclusionsThe NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs.Implications for PracticeIdentifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well‐being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high‐quality PC services. Providing support to parents during the transition to parenthood would also be beneficial.Reporting MethodThis paper adheres to the STROBE initiative guidelines.Contribution from patients or members of the publicParticipants, who voluntarily agreed to take part, contributed to the study by completing a paper‐based questionnaire containing all the study variables as prepared by the research team.

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Frequent users in paediatric emergency departments. Who are they? Why do they consult?

Cited by 8 publications

References 17 publications

Paediatric frequent use of emergency medical services: a systematic review

Paediatric frequent use of emergency medical services: a systematic review

Utilizadores Frequentes da Urgência Pediátrica: Conhecer, Intervir e Analisar - Um Estudo Piloto

Factors associated with non‐urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross‐sectional descriptive study

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