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Why do parents present to the Paediatric Emergency Department with conditions suitable for management in less acute
Kirsty McLauchlan1, Shammi Ramlakhan2, Andy Irving3
1St Mary's Hospital, Imperial College London, London.
Insights
Parental uncertainty about their child's condition and a desire for the best care often lead to visits to the Paediatric Emergency Department (PED) for non-urgent issues. Strategies should focus on supporting these children within the PED.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Parental Decision-Making
Background:
- Many children attending Paediatric Emergency Departments (PEDs) present with conditions manageable in less acute settings.
- Understanding parental decision-making is crucial for optimizing emergency care utilization.
Purpose of the Study:
- To identify factors influencing parental attendance at a PED for conditions not requiring emergency care.
- To inform strategies for managing non-urgent pediatric cases.
Main Methods:
- Semi-structured interviews with parents of children in the two lowest triage categories at an urban PED.
- Exploration of care-seeking behaviors during unscheduled urgent situations.
Main Results:
- Parents prioritize accessing the most appropriate care for their child.
- Key influences include perceived urgency, parental uncertainty, perceived need for specialized PED resources, and awareness of alternatives.
- Prior referrals to the PED from other services impacted current attendance decisions.
Conclusions:
- Parental uncertainty and risk aversion contribute to PED use for minor pediatric conditions.
- Future efforts should focus on enhancing care for non-urgent cases within the PED, rather than solely discouraging attendance.
Objective:
To determine the factors influencing attendance at a Paediatric Emergency Department with conditions suitable for management in less acute settings.
Methods:
Semi-structured interviews exploring parental decision-making processes surrounding care-seeking behaviours in urgent situations were undertaken with parents of children allocated to the two lowest triage categories at a type-1 urban Paediatric Emergency Department over two 2-week periods.
Results:
All parents expressed a desire to access care from the most appropriate service for their child in unscheduled situations. A number of factors influenced parental perceptions of appropriateness: (1) perceptions concerning the urgency or severity of a condition; (2) uncertainty regarding their assessment of the severity or urgency of a problem; (3) the possibility that a condition may require resources available solely at the Paediatric Emergency Department; and (4) awareness of alternative services. Parents reported that previous utilisation of alternative services, which lead to them being referred onwards to the Paediatric Emergency Department, influenced their decision to attend the Paediatric Emergency Department on this occasion.
Conclusion:
Parental uncertainty and a low tolerance of risk among parents and healthcare professionals increases the likelihood of emergency department attendance. Parents are likely to continue to utilise the Paediatric Emergency Department for minor conditions. Future strategies should focus on improving outcomes for children with non-urgent problems who access care at the emergency department rather than discouraging utilisation.
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