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Frequent emergency department use in the paediatric population: A systematic literature review
Theodoros V Giannouchos1,2, David J Washburn1, Jodie C Gary3
1School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA.
Insights
Frequent pediatric emergency department (ED) users often have complex health needs and face access barriers. Improving care coordination and access to primary providers can reduce unnecessary ED visits for these children.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Healthcare Access
Background:
- Frequent emergency department (ED) use in children is a significant concern for healthcare systems.
- Understanding the characteristics of frequent pediatric ED users is crucial for developing targeted interventions.
- Previous research has explored factors contributing to high ED utilization, but a synthesized overview is needed.
Purpose of the Study:
- To systematically review and synthesize the literature on pediatric frequent emergency department (PFED) users in the United States.
- To identify and analyze the characteristics and factors associated with frequent ED utilization in this population.
Main Methods:
- A comprehensive literature search was conducted in Medline, CINAHL, and Embase databases for studies published after 1990.
- Studies focusing on US-based analyses of PFED users, excluding specific subgroups, were selected.
- Two independent reviewers screened articles and extracted data on predisposing, enabling, behavioral, need, and reinforcing factors.
Main Results:
- Fifteen studies met the inclusion criteria, with PFED users representing 3-14% of all pediatric ED visits.
- Frequent users were often under 5 years old, had public insurance, and resided in disadvantaged areas.
- Chronic conditions, complex health needs, and a history of hospitalization were associated with frequent ED use, while having a regular primary care provider was associated with less frequent use.
Conclusions:
- Frequent pediatric ED users often have unmet healthcare needs and face challenges in accessing timely care.
- Healthcare systems should prioritize interventions that improve care coordination and expand access to non-ED care settings.
- Educating caregivers and enhancing access to primary and specialty care providers are key strategies to reduce unnecessary ED visits.
Objective:
We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States.
Methods:
We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors.
Results:
Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use.
Conclusions:
Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
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