Practice characteristics that influence nonurgent pediatric emergency department utilization

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Emergency Medicine

Background:

• Nonurgent visits to pediatric emergency departments (PEDs) contribute to overcrowding and increased healthcare costs.
• Understanding the factors driving nonurgent PED utilization is crucial for optimizing primary care services.

Purpose of the Study:

• To identify specific characteristics of primary care pediatric practices associated with nonurgent use of the PED.
• To develop predictive models for nonurgent PED visits based on practice attributes.

Main Methods:

• Prospective collection of data on primary care practice characteristics from 33 pediatric practices.
• Retrospective analysis of urgent and nonurgent visits to the PED for patients within these practices.
• Discriminant analysis classification model to differentiate between urgent and nonurgent PED utilization.

Main Results:

• Out of 31,076 PED visits, 47% were classified as nonurgent.
• Predictive factors for nonurgent utilization included a higher percentage of patients with Medicaid, fewer available sick slots per physician, closer proximity to the PED, specific nurse triage protocols, acceptance of walk-in sick visits, and rapid laboratory test turnaround.

Conclusions:

• Nonurgent PED utilization is predictable using specific, potentially modifiable, primary care practice characteristics.
• Implementing targeted interventions based on these predictive factors can help reduce PED overcrowding and enhance care continuity.
• Optimizing pediatric services and policies informed by these findings can mitigate high volumes of nonurgent PED visits.