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Avoidable visits to the paediatric emergency department: associated factors and lessons learned from the pandemic
João Viana1,2, João Vasco Santos3,4,5, Andreia Pinto3,4
1MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal. joaoviana@med.up.pt.
Insights
Avoidable emergency department (ED) visits saw a slight decrease during the COVID-19 pandemic. Factors like age, time of day, and prior visits influenced these admissions, with return visits becoming more likely to be avoidable post-pandemic.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Policy
- Healthcare System Analysis
Background:
- Avoidable emergency department (ED) visits represent a significant burden on healthcare systems.
- Understanding factors contributing to these visits is crucial for optimizing resource allocation and patient care.
- The COVID-19 pandemic potentially altered patterns of healthcare utilization, including ED visits.
Purpose of the Study:
- To identify factors associated with avoidable ED admissions.
- To compare these factors between the pre-COVID-19 and COVID-19 periods.
Main Methods:
- Retrospective study design.
- Analysis of paediatric ED visits at a metropolitan, university-affiliated hospital in Portugal.
- Data collected for visits between 2014 and 2020, encompassing pre-COVID and COVID periods.
Main Results:
- A 7.2% decrease in avoidable visits was observed between pre-COVID and COVID periods.
- Factors associated with reduced avoidable visits included older age, early morning admission (4-7 a.m.), referral, and prior ED visits within 72 hours.
- Increased likelihood of avoidable visits was linked to ages 3-5 years, summer season, and evening visits (8-11 p.m.).
- A significant shift was noted: prior 72-hour ED visits, previously protective, became associated with a higher likelihood of avoidable visits during the pandemic.
Conclusions:
- The modest reduction in avoidable ED visits suggests a chronic issue within the healthcare system's structure and usage.
- Avoidable ED visits are multifactorial, not driven by a single cause.
- Findings can inform targeted policy interventions to mitigate avoidable ED admissions.
Purpose:
The main goal of this study is to identify the associated factors with avoidable admissions in ED, comparing pre-COVID and COVID periods.
Methods:
This was retrospective study that took place in a Paediatric Emergency Department of a metropolitan, university-affiliated hospital in Portugal. All visits to paediatric emergency department between 2014 and 2020 were considered.
Results:
There was a decrease of 7.2% points in avoidable visits between pre-COVID and COVID periods. Considering both periods, this study identifies older ages, being admitted to the paediatric emergency department between 4 and 7 a.m., referral and having visited the emergency department previously within 72 h as major factors associated with a reduced likelihood for avoidable visits. On the other hand, it identifies an increased likelihood of avoidable visits in the 3 to 5 years old age group, visits that occurred during the Summer and visits that occurred between 8 and 11 p.m. When considering what changed between pre-COVID and COVID periods, while having visited the paediatric emergency department 72 h prior made it less likely for the patient to be an avoidable visit during the pandemic period, this tendency has inverted, making it more likely for return visits to be avoidable.
Conclusions:
The relatively low decrease in avoidable visits' ratios between pre-COVID and COVID periods, associated with the similar distribution of attendance during the day and lower odds ratio of avoidable visits during periods when primary care is available, suggests that avoidable visits are a chronical problem of the National Health system's structure and its usage, not having a single factor nor a combination of factors as a driving force. Nevertheless, this study identified several factors associated with avoidable visits to the emergency department. Therefore, it can aid policy makers to create targeted interventions to mitigate this problem.
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