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Why do parents bring children to the emergency department for nonurgent conditions? A qualitative study
Anne Berry1, David Brousseau, Jane M Brotanek
1Pennsylvania State College of Medicine, Hershey, PA, USA.
Insights
Parents often choose the pediatric emergency department (ED) for nonurgent issues due to primary care provider (PCP) access problems and perceived ED advantages. Improving PCP efficiency and scheduling could reduce nonurgent ED visits.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Qualitative Research
Background:
- Nonurgent pediatric emergency department (ED) visits represent a significant portion of healthcare utilization.
- Limited research exists on parental motivations for choosing the ED for nonurgent pediatric care over primary care providers (PCPs).
Purpose of the Study:
- To identify and understand parents' reasons for selecting the ED instead of their child's PCP for nonurgent healthcare needs.
Main Methods:
- Conducted audiotaped ethnographic interviews with parents of children seeking nonurgent care at a children's hospital ED.
- Interviews were conducted in English and Spanish during weekday business hours over a four-week period.
Main Results:
- Key reasons for ED use included long PCP appointment waits, dissatisfaction with PCPs, communication barriers, referrals, and perceived ED efficiency, convenience, and expertise.
- Parents expressed a desire for educational resources regarding the urgency of pediatric conditions.
Conclusions:
- Parental decisions to use the ED for nonurgent pediatric care are influenced by issues with their PCP, referrals, and perceived benefits of the ED.
- Reducing nonurgent pediatric ED visits may necessitate enhancing PCP accessibility, efficiency, patient experience, and appointment systems.
Objective:
Nonurgent conditions account for 58% to 82% of pediatric emergency department (ED) visits, but only 1 preliminary qualitative study has examined reasons why parents bring children to the ED for nonurgent care. The aim of this study was to identify parents' reasons for choosing the ED over their primary care provider (PCP) for nonurgent pediatric care.
Methods:
Audiotaped ethnographic interviews in English and Spanish were conducted of parents of children presenting for nonurgent care on weekdays from 8 AM to 4 PM at a children's hospital ED over a 4-week period.
Results:
For the 31 families interviewed, the mean parental age was 28 years, and mean child age, 3 years. Reasons cited by caregivers for choosing the ED over their child's PCP were long appointment waits, dissatisfaction with the PCP, communication problems (accents and unhelpful staff at PCP), health care provider referral, efficiency, ED resources, convenience, quality of care, and ED expertise with children. Some parents said they would like education on the urgency of pediatric problems.
Conclusions:
Parents bring their children to the ED for nonurgent care because of problems with their PCP, PCP referral, and perceived advantages to ED care. Although parents report that education on the urgency of pediatric conditions would be helpful, substantial reduction of pediatric nonurgent ED use may require improvements in families' PCP office access, efficiency, experiences, and appointment scheduling.
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