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Understanding Low-Acuity Visits to the Pediatric Emergency Department
Ken J Farion1, Megan Wright2, Roger Zemek1
1Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Many parents use pediatric emergency departments for low-acuity issues, even with a primary care provider. Improving access to primary care and educating parents on appropriate care options can reduce emergency department overuse.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Primary Care Access
Background:
- Canadian pediatric emergency department (ED) visits are rising, with a significant increase in low-acuity cases.
- Low-acuity visits constituted 41% of ED volume in 2011-12, up from 33% in 2008-09.
Purpose of the Study:
- To investigate presentation patterns and resource use for low-acuity pediatric ED visits.
- To understand parental perceptions, motivations, and alternative care-seeking behaviors before ED presentation.
- To identify differences in presentation between children with and without a primary care provider.
Main Methods:
- Prospective cohort study at a tertiary pediatric ED serving two provinces.
- Anonymous surveys administered to parents of children with low-acuity visits during four 2-week periods over one year.
- Data linkage between surveys and clinical data (presentation times, interventions, diagnoses, dispositions).
Main Results:
- 2,443 surveys completed (74.1% response rate); 2,146 linked survey-data collection form pairs.
- 89.7% of patients had a primary care provider; 40% of visits occurred during office hours.
- Only 25% of parents contacted their primary care provider; 36% believed ED was necessary, though 45% only needed reassurance.
- Patients without a primary care provider were more likely to present during office hours and were unaware of other care options.
Conclusions:
- A significant number of low-acuity pediatric visits to the emergency department occur despite the availability of primary care providers.
- Enhancing timely access to primary care physicians is crucial for reducing pediatric ED overuse.
- Parental education on managing low-acuity conditions and directing them to appropriate care settings is recommended.
Background:
Canadian 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.
Methods:
We 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.
Results:
Parents 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).
Conclusions:
Many 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.
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