Pediatric emergency department utilization habits: a consumer survey

The objective of this study was to identify pediatric emergency department (PED) utilization patterns to develop areas for future educational interventions. To this end a verbally administered questionnaire by a single interviewer was given over 17 days between February 8, 1993, through April 7, 1993, at a PED of an urban university hospital. Participating were 300 families (convenience sample) who were interviewed at varying times of the day and night. They represented about 20% of PED visits during the survey days. Each parent was surveyed about his/her child's health. Parents were also asked to indicate on a linear scale how sick they believed their child was. The mean patient age was 3.8 +/- 4.3 years; 81% were African-American, 15% were Caucasian, and 2% were Hispanic; 65% had medical assistance (MED), 21% had commercial insurance (COM), and 4% had both. Ten percent either had no insurance or their insurance status was unknown. Thirty-four percent of patients utilized a community clinic for primary health care, 32% identified a private physician, and 28% used the hospital's pediatric clinic. The most commonly stated reasons for coming to the PED differed between the MED and COM groups; 14% of the MED group was referred compared to 59% of the COM group (P = 0.002, chi 2), 24% of the MED group came because their primary care provider's office was closed compared to 3% of the COM group (P < 0.01, chi 2). Seventy-one percent of COM group called their primary care provider before coming to the PED compared to 27% of MED group (P < 0.001, chi 2). Analysis of parental rating of their child's illness severity on a linear (10-point) scale showed a mean of 5.7 +/- 2.5. The COM group had lower triage scores (indicating greater severity of illness) than the MED group: 50% COM patients were scored < or = 2.5 compared to 30% of MED patients (P < 0.01, chi 2). We found a significant difference in the PED utilization habits of patients on medical assistance compared to those with commercial insurance, and we plan to develop educational materials to meet the needs of our patients, many of whom utilize the PED for nonurgent illnesses.