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Physician and Parental Decision-Making Prior to Acute Medical Paediatric Admission
Rebecca Barwise-Munro1, Heather Morgan2,3, Steve Turner4
1Child Health, University of Aberdeen, Aberdeen AB24 3FX, UK. r.barwisemunro@btinternet.com.
Insights
Parents and clinicians often err on the side of caution, influenced by parental anxiety and expectations, contributing to rising paediatric emergency admissions. Interventions targeting these factors could reduce unnecessary hospital visits.
Area of Science:
- Pediatric Emergency Medicine
- Qualitative Research
- Health Services Research
Background:
- Rising rates of acute medical paediatric emergency admissions present a significant healthcare challenge.
- Understanding non-clinical factors influencing admission decisions is crucial for effective healthcare management.
- Qualitative insights are needed to explore parental and clinician decision-making processes.
Purpose of the Study:
- To explore parental and clinician decision-making factors influencing paediatric emergency admissions.
- To identify potential interventions to mitigate the rise in short-stay acute medical admissions.
- To understand the role of parental anxiety and expectations in healthcare seeking behaviour.
Main Methods:
- Conducted semi-structured interviews with parents, referring clinicians (general practice, out-of-hours, emergency department), and receiving clinicians (acute medical paediatrics).
- Interviewed 10 parents, 7 referring clinicians, and 10 receiving clinicians.
- Analyzed qualitative data to identify recurring themes in decision-making.
Main Results:
- Parents reported "erring on the side of caution" and experiencing anxiety when seeking medical care.
- Referring clinicians also "erred on the side of caution," managed "parental anxiety," and relied on "gut instinct."
- Receiving clinicians identified managing parental anxiety and increasing parental expectations as key themes.
Conclusions:
- Decision-making processes of parents and referring clinicians offer "teachable moments" for intervention.
- Targeted interventions can potentially reduce short-stay acute medical paediatric admissions.
- Addressing parental anxiety and expectations may improve healthcare resource utilization.
Background:
The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission.
Methods:
Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians).
Results:
Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described "erring on the side of caution" when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, "erring on the side of caution" was also identified as was managing "parental anxiety" and acting on "gut instinct". Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service.
Conclusions:
The study of parent and referring clinician decision-making prior to a hospital admission can identify "teachable moments" where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as "parental anxiety".
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