The district hospital emergency department: Why do parents present?

Abstract

Objective: To identify parental reasons for presenting their child to the emergency department and their expectations of the consultation. Method: Cross‐sectional survey of parents of children and adolescents aged 14 years and under who presented to the Fairfield Emergency Department over a 2‐month period. Results: A questionnaire was returned from 694 of 839 eligible presentations (83%), with 51% having an urgent triage and 26% being admitted. Proximity was nominated as the reason for choosing the Fairfield Emergency Department by 48%, 62% of presentations were self‐referred and 44% had already seen another doctor. An urgent triage was associated with parental expectation of admission or observation in the emergency department (OR 2.79 [95% CI: 1.98–3.94]). Conclusions: The majority of presentations to the district emergency department are self‐referred and it is chosen because of proximity. The majority of children do not require admission; however, parents often have expectations that observation and further investigation will occur prior to discharge from the emergency department.

Emergency department use in a rural Australian setting: are the factors prompting attendance appropriate?

“…This result is consistent with previous findings by Cooper et al 14 whose study suggested that parents largely based appropriateness of attending the ED not on the severity or length of the child' s illness but on other factors such as proximity to the ED. It could also be interpreted that the catchment has a youthful population, however other studies have also identified infants, adolescents and young adults as the most common groups presenting to the ED.…”

“…5 It has been suggested that factors such as "consumer choice, free services, one stop shopping or the ageing population" represent reasons for the increasing demands on emergency services. 4 Other investigators have identified proximity, general practitioner referral, medical necessity, ED preference, accessibility, affordability, and GP unavailability as factors contributing to increased ED presentations, 6,7,9,[14][15][16] however there has been no conclusive evidence to confirm that this equates to inappropriate ED use. A presentation which may be considered appropriate within one ED, such as in a rural service, may be considered entirely inappropriate within another ED, such as in a metropolitan service.…”

“…The questionnaire (Appendix) was designed by the second author (LB) to incorporate emergency attendance factors identified in previous studies 9, [14][15][16] Closed-ended questions related to respondents' perceptions of: whether their attendance at the ED was an emergency; the urgency of the case; factors influencing their ED attendance; duration of the condition prompting ED attendance; care to date of this condition; and whether the respondent was referred to the ED. Respondents could provide multiple factors influencing ED attendance.…”

“Medical Emergency Services as Seen by Consumers”. Health Services Research by CATI Survey of the Community

“…Studien aus Deutschland, den Niederlanden und der Schweiz zu diesem Themenfeld, also ärztliche Notfalldienste und deren Inanspruchnahme, belegen allerdings eine hohe Rate von Selbsteinweisungen in Klinikambulanzen unter "Umgehung" des ärzt-lichen Notfalldienstes [4,11,18,28,34,38,41].…”

“…Auch andere internationale Studien dokumentieren einen hohen Anteil von Selbsteinweisungen in Klinikambulanzen und kommen zu dem Schluss, dass die Mehrzahl der Fälle durch Hausärz-te behandelt werden könnte oder durch den Hausarzt begutachtet und fachgerecht eingewiesen werden sollte [3,4,10,15,23,29].…”