Related Experiment Video
Updated: Jul 27, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Noncompliance with scheduled revisits to a pediatric emergency department
R J Scarfone1, M D Joffe, J F Wiley
1Department of Pediatrics, Temple University School of Medicine, Philadelphia, Pa, USA.
Insights
Over half of parents were noncompliant with scheduled pediatric emergency department (ED) revisits. Key risk factors for noncompliance include parental perception of illness severity and socioeconomic status.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Compliance
- Patient Outcomes
Background:
- Noncompliance with scheduled revisits to pediatric emergency departments (EDs) is a significant concern.
- Understanding the factors contributing to noncompliance is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To investigate the incidence, risk factors, and consequences of noncompliance (NC) with scheduled revisits in a pediatric ED.
- To identify specific parental and visit-related factors associated with NC.
Main Methods:
- A prospective, inceptive cohort study was conducted in an urban pediatric ED.
- Data were collected through interviews with parents and physicians of 179 children.
- Risk factors for NC were analyzed using relative risk (RR) and confidence intervals (CI).
Main Results:
- The overall rate of noncompliance with scheduled revisits was 51%.
- Significant risk factors for NC included parental belief that the child was not severely ill (RR, 2.92), inability to recognize deterioration (RR, 1.95), lack of car ownership (RR, 1.77), younger parental age (RR, 1.48), no initial laboratory testing (RR, 1.36), and parental uncertainty about returning (RR, 1.34).
- Only 21% of noncompliance was attributed to the child being better.
Conclusions:
- The high and unpredictable rate of noncompliance necessitates adjustments in patient disposition strategies.
- Identified risk factors can inform targeted interventions to enhance compliance with follow-up ED visits.
- This study provides a foundation for developing models to predict and mitigate noncompliance in pediatric ED settings.
Objectives:
To determine the incidence of, the risk factors associated with, and the consequences of noncompliance (NC) with a scheduled revisit to a pediatric emergency department (ED).
Design:
A prospective, inceptive cohort study.
Setting:
An urban pediatric ED.
Patients:
A sample of 179 children.
Interventions:
Interviews of parents and physicians.
Results:
Overall, 91 (51%) of the parents were noncompliant, and just 21% were noncompliant because "the child was better." Of the 124 patients who ED physicians believed were "certain to return," 57 (46%) were noncompliant. Six factors were associated with NC: (1) the parent believed that the child was not severely ill (relative risk [RR], 2.92; 95% confidence interval [CI], 1.31-6.49); (2) the parent was judged to be unable to recognize a clinical deterioration of the child (RR, 1.95; 95% CI, 1.55-2.45); (3) the parent did not own a car (RR, 1.77; 95% CI, 1.23-2.54); (4) the parent was younger than 21 years (RR, 1.48; 95% CI, 1.12-1.95); (5) no laboratory testing was performed during the initial ED visit (RR, 1.36; 95% CI, 1.03-1.80); and (6) the parent was judged "not certain" to return (RR, 1.34; 95% CI, 1.01-1.78).
Conclusions:
The high rate and the lack of predictability of NC with a scheduled revisit to an ED should influence patient disposition decisions. The factors associated with NC in this study may serve as a model for identifying parents who are at a high risk of NC and as a foundation for interventions designed to improve compliance.
Related Concept Videos
01:08Obedience
01:26Methods of Documentation II: POMR
01:26Types of Reports III: Telephone and Verbal Reports
Here's an overview of each type:
Telephone Orders
01:29Drug Dosing: Infants and Children