Understanding Low-Acuity Visits to the Pediatric Emergency Department

Abstract

BackgroundCanadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents’ perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems.MethodsWe conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number.ResultsParents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child’s problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (p = 0.003), have longer symptom duration (p<0.001), and not know of other options (p = 0.001).ConclusionsMany parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.

Comparison of methods used to quantify general practice‐type patients in the emergency department: A tertiary paediatric perspective

“…As expected there is a greater proportion of GP‐type patients in the paediatric ED in comparison with the 10–12% seen in adult tertiary hospitals . This is in keeping with international PEDs where GP‐type patients range from 40 to 47% . This is likely because of lack of access to GP appointments, lack of access to a known trusted GP, language difficulties, transportation difficulties and, most overwhelmingly, the parental perception that the PED is the appropriate place for their child at that time .…”

“…1 This is in keeping with international PEDs where GP-type patients range from 40 to 47%. 12,18,19 This is likely because of lack of access to GP appointments, 19,20 lack of access to a known trusted GP, language difficulties, transportation difficulties 21 and, most overwhelmingly, the parental perception that the PED is the appropriate place for their child at that time. 6,13,16,22,23 Reliance on PEDs has occurred as increasingly well-trained paediatric emergency physicians staff the PEDs and address parental anxieties.…”

Utilização do serviço de urgência pediátrica: a experiência de um centro português

“…Alguns autores afirmam que esforços educacionais junto aos cuidadores podem ter efeitos sobre comportamentos mais responsáveis na utilização de serviços de saúde [5]. Foi inclusive possível demonstrar que os serviços prestados por assistentes sociais, com o intuito de ajudar os doentes a encontrar alternativas adequadas de prestação de cuidados de saúde em nível primário, por meio de aconselhamento, encaminhamento e articulação com recurso à comunidade, têm apresentado resultados bastante satisfatórios na taxa de reincidência ao serviço de urgência de crianças com necessidades pouco urgentes [32].…”

Emergency Department Revisits by Urban Immigrant Children in Canada: A Population-Based Cohort Study

“…13 The number of low-acuity visits in the preceding year for each patient was used to account for the predilection for using the ED as a source of health care for nonurgent needs, a measure that has been shown to reflect primary care access. 21,22 All-cause ED use has been shown to reflect greater health care needs or comorbidities in adults and was used as a covariate. 23,24 The CTAS score was used to account for severity of illness.…”