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Factors associated with the inappropriate use of the pediatric emergency department. A systematic review
Néstor Montoro-Pérez1, Miguel Richart-Martínez2, Raimunda Montejano-Lozoya3
1Department of Nursing, Faculty of Health Science, University of Alicante, Spain; GREIACC Research Group, La Fe Health Research Institute, Valencia, Spain.
Insights
Inappropriate pediatric emergency department (PED) use is linked to caregiver demographics, emotions, and perceived access barriers. Understanding these factors is key to reducing unnecessary consultations and healthcare system strain.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
- Public Health
Background:
- Pediatric emergency department (PED) admissions are increasing without a corresponding rise in severe pediatric pathologies.
- This study investigates the multifaceted factors contributing to the inappropriate utilization of PEDs.
Approach:
- A systematic review was conducted following PRISMA guidelines, searching major scientific databases (PubMed, Web of Science, Science Direct) from January 2017 to August 2022.
- Quality assessment of included studies was performed using established criteria (STROBE, CASPe, AMSTAR-2, GRADE).
Key Points:
- Inappropriate PED use is associated with younger child age, Black caregivers, lower socioeconomic status, and lower parental education.
- Parental factors such as perceived urgency, emotional responses to health issues, psychological distress, and ineffective role-playing contribute significantly.
- Perceived advantages of PEDs and health insurance characteristics also play a role in utilization patterns.
Conclusions:
- The phenomenon of inappropriate PED demand is complex and heterogeneous.
- Identifying these contributing factors from a healthcare professional's viewpoint is crucial for developing targeted interventions.
- Effective interventions can help reduce unnecessary consultations, thereby alleviating pressure on healthcare services.
Background:
Pediatric emergency department (PED) admissions have risen in recent years, a trend not justified by the severity of the pathologies presented. The aim of this study is to analyse factors related to the inappropriate use of pediatric emergency departments.
Methods:
This is a systematic review reported in accordance with the PRISMA statement. We searched the PubMed, Web of Science and Science Direct databases, using keywords extracted from MeSH, and conducted a reverse search using Google Scholar and Open Grey, for the period January 2017 to August 2022. The quality of the papers was assessed using STROBE, CASPe, AMSTAR-2, GRADE, Levels Of Evidence and Grades Of Recommendation.
Results:
A total of 20 studies were selected. Factors related to inappropriate use included the younger age of children, black caregivers, lower socioeconomic status, lower parental educational attainment, perceived urgent demand for care, parental emotions in response to their children's health problems, psychological distress, the ineffective exercise of the parental role, the advantages of the PED and the nature of health insurance.
Conclusions And Implications:
The results illustrate the heterogeneous nature of the phenomenon under investigation. Gaining an understanding of the factors related to the inappropriate demand of PEDs, from the perspective of health professionals, can help in developing interventions to reduce unnecessary consultations and relieve pressure on these healthcare services.
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