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Published on: February 2, 2017
Paediatric frequent attenders at emergency departments: a linked-data population study
Nicholas P Gibson1, George A Jelinek, Moyez Jiwa
1Discipline of Emergency Medicine and School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Nedlands, WA 6009, Australia. nick.gibson@uwa.edu.au
Insights
This study analyzed frequent pediatric emergency department (ED) attenders in Perth. Children with frequent ED visits often had respiratory or infectious conditions, suggesting targeted interventions.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Epidemiology
Background:
- Frequent attendance at emergency departments (EDs) by children is a concern for healthcare systems.
- Understanding the characteristics of frequent attenders (FAs) is crucial for developing targeted interventions.
- Previous research has explored adult FAs, but paediatric populations require specific investigation.
Purpose of the Study:
- To characterize the demographic, clinical, and dispositional features of frequent paediatric attenders (FAs) in Perth, Western Australia.
- To identify patterns and potential underlying causes for high ED utilization among children.
- To inform strategies for managing paediatric ED demand and improving care pathways.
Main Methods:
- A linked data population study was conducted using records of all children under 15 years attending Perth hospital EDs from July 1, 2000, to December 31, 2006.
- Frequent attenders were defined as those visiting the ED five or more times annually.
- Data collected included demographic characteristics, mode of arrival, urgency, clinical conditions, and disposition, analyzed by attendance frequency.
Main Results:
- Over 6.5 years, 229,883 children made 378,068 annualised ED visits (mean 1.5 per child).
- Most children (98.2%) attended EDs fewer than five times annually.
- Increasing attendance frequency was associated with being male, younger age, self-referral, ambulance arrival, and a higher prevalence of respiratory or infectious disorders. Those attending 10-19 times annually showed increased urgency, respiratory disease, and admission rates (P < 0.001). Children attending >20 times had serious chronic illnesses.
Conclusions:
- Paediatric frequent attenders (5-9 visits/year) may not be significantly sicker or more in need of hospital services than less frequent attenders.
- Respiratory and infectious disorders were common across all FA groups, indicating a potential focus for further research and intervention.
- A holistic approach considering parental expectations and a systems-level strategy to modify ED attendance behaviour is recommended.
Aim:
To characterise the phenomena of paediatric frequent attenders (FAs) to emergency departments (EDs) in Perth.
Methods:
A linked data population study of all children (<15 years) attending Perth hospital EDs between 1 July 2000 and 31 December 2006. FAs attending five or more times annually were assessed for demographic characteristics, mode of arrival, urgency, clinical conditions and disposition by frequency of attendance.
Results:
Over 6.5 years, 229, 883 children contributed to 378, 068 annualised chains of events (mean 1.5). Most children (98.2%) attended EDs less than five times a year. The more frequently children attended, the more likely they were to be male, younger, self-referred, have respiratory or infectious disorders, and to arrive by ambulance. Characteristics of those attending 0-4 (n= 371 171) and 5-9 (n= 6405) times per year were broadly similar, while those attending 10-19 times per year (n= 461) were more urgent, had a higher frequency of respiratory disease and higher admission rates (all P < 0.001). Those attending more than 20 times a year (n= 31) had serious chronic illness.
Conclusions:
Frequent attenders of 5-9 times a year may be no sicker or more in need of hospital services than those who attend less frequently. The preponderance of respiratory and infectious disorders across all FA groups suggests these could be the focus of further research. We advocate a holistic approach to take into account parental expectations, and a systems approach to change ED attendance behaviour.
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