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Appropriate use of a pediatric emergency department: is the pediatrician called before the visit?
S D Berns1, J G Linakis, W J Lewander
1Department of Pediatrics, Rhode Island Hospital, Brown University, Providence 02903.
Insights
This study found that the appropriateness of pediatric emergency department (ED) visits is not dependent on the type of pediatrician. However, nonprivate patients were less likely to contact their pediatrician before an ED visit due to access issues.
Area of Science:
- Pediatrics
- Health Services Research
Background:
- Urban pediatric emergency departments (EDs) often manage patients with access to private or nonprivate pediatricians.
- Understanding factors influencing ED utilization is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To assess the appropriateness of urban pediatric ED use among children with pediatricians.
- To identify factors associated with contacting a pediatrician before an ED visit.
Main Methods:
- Prospective, randomized study in an urban teaching hospital pediatric ED.
- 166 pediatric patients (≤18 years) with nontraumatic conditions and a pediatrician were enrolled.
- Questionnaires and established criteria were used to determine visit appropriateness.
Main Results:
- No significant difference in ED visit appropriateness between private and nonprivate patients.
- Parents who contacted their pediatrician had a higher rate of appropriate ED visits (65% vs. 55%).
- Private patients contacted physicians more frequently; nonprivate patients cited access issues as a barrier.
Conclusions:
- The appropriateness of pediatric ED visits is independent of pediatrician type.
- Access limitations contribute to nonprivate patients less frequently consulting pediatricians before ED visits.
- Addressing access barriers may improve appropriate healthcare seeking behaviors.
Abstract:
The objective of this study was to examine the appropriateness of utilization of an urban pediatric emergency department (ED) by children who had a pediatrician and factors relating to whether the pediatrician was called before an ED visit. This was done prospectively and randomly in an urban teaching hospital pediatric ED. One hundred and sixty-six patients, 18 years old and younger, who presented for nontraumatic conditions and had a pediatrician, classified as private or nonprivate, were enrolled. A questionnaire was completed and appropriateness of visit was determined using previously published criteria. No difference in appropriateness of visit was found between private and nonprivate patients (58/98, 40/68, NS). Thirty-five of 54 (65%) parents who called their pediatrician were classified as an appropriate ED visit as opposed to 62 of 112 who did not call (55%, NS). Private patients called their physicians more often then nonprivate patients (P < 0.001). Lack of access to their primary care providers was the more common reason among nonprivate patients (P < 0.05) for not calling their pediatricians. We conclude that appropriateness of pediatric ED visits is independent of type of physician. Nonprivate patients tend to consult their physician less often before ED visits because of access problems.
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