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Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up?
Mélanie Freiermuth1, Christopher J Newman1,2, Judit Villoslada3
1Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland.
Insights
Parental adherence to emergency department (ED) referrals from medical call centres was 75%. Adherence decreased with greater distance to the ED, but child characteristics did not influence it. Key reasons for non-adherence included symptom improvement.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Telehealth
Background:
- Medical call centres provide crucial triage and referral services for pediatric patients.
- Understanding adherence to these referrals is vital for optimizing healthcare access and patient outcomes.
- Previous research has not fully elucidated factors influencing parental adherence to call centre-based ED referrals.
Purpose of the Study:
- To determine parental adherence rates to emergency department (ED) referrals initiated by medical call centre nurses for pediatric patients.
- To investigate how adherence varies based on child characteristics.
- To identify parental reasons for non-adherence to ED referrals.
Main Methods:
- Prospective cohort study conducted in Lausanne, Switzerland (February-March 2022).
- Included pediatric calls (<16 years) with an ED referral, excluding life-threatening emergencies.
- Parental adherence verified in the ED; non-adherence reasons collected via telephone questionnaire.
Main Results:
- Overall parental adherence to ED orientation was 75%.
- Adherence significantly decreased as the distance between the call origin and the ED increased.
- Child's age, sex, and health complaints did not impact adherence.
Conclusions:
- Parental adherence to pediatric medical call centre referrals is substantial but can be improved.
- Geographic distance to the emergency department is a significant barrier to adherence.
- Symptom improvement and alternative care seeking (e.g., pediatrician appointments) are primary reasons for non-adherence, highlighting opportunities for service optimization.
Abstract:
Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children's characteristics and (3) to assess parents' reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child's age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child's condition (50.7%), parents' decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence.
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