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Physician parents and utilization of a pediatric emergency department
D S Diekema1, M A Del Beccaro, P Cummings
1Department of Pediatrics, School of Medicine, University of Washington, Seattle, USA.
Insights
Children with physician parents are less likely to visit the pediatric emergency department (ED) for nonurgent issues. However, parental education alone may not reduce overall ED use for treatable conditions.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Healthcare Economics
Background:
- Emergency department (ED) utilization for nonurgent conditions contributes to increased healthcare costs.
- Understanding factors influencing parental decisions for seeking emergency care is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate whether children with physician parents, possessing expertise in illness severity, utilize pediatric emergency departments differently than children with non-physician parents.
- To compare the ED utilization patterns of children with physician parents to those with nurse parents and attorney parents.
Main Methods:
- Retrospective cohort study conducted at a children's hospital emergency department.
- Compared children with physician parents (n=72) to randomly selected controls (n=1000).
- Additional comparisons included children with nurse parents (n=136) and attorney parents (n=135).
Main Results:
- No significant differences were observed in age, sex, presentation time, disposition, or nursing acuity between groups.
- Children with physician parents were less likely to have a nonurgent final diagnosis (33% vs. 53%; RR 0.62).
- Children with nurse or attorney parents showed no significant difference in nonurgent diagnosis rates compared to controls.
Conclusions:
- Physician parents' children demonstrated reduced nonurgent pediatric emergency department visits.
- Children of nurse parents exhibited similar ED utilization patterns to control children, despite higher parental medical education.
- Findings suggest that parental education alone may not be sufficient to decrease emergency department use for nonurgent conditions.
Objective:
Health care costs might be reduced if patients could be taught to avoid using an emergency department (ED) for nonurgent illness. This study sought to determine whether children with a physician parent, a group whose parents possess special expertise in judging the severity of acute illness, utilize a pediatric ED differently from children with non-physician parents.
Design:
Retrospective cohort study.
Setting:
A children's hospital ED.
Participants:
The study population consisted of all children who visited the ED over an 11-month period who had a physician parent. These children were compared to 1000 controls randomly selected from children who visited the ED over the same time period. Two other groups were selected for comparison to controls: children with a nurse parent and children with an attorney parent.
Main Outcome Measures:
Urgent versus nonurgent final diagnosis.
Results:
There were no clinically important or statistically significant differences with regard to age, sex, time of presentation, disposition from the ED, or nursing acuity level when the 72 children with a physician parent, the 136 children with a nurse parent, or the 135 children with an attorney parent were compared to the control children. Compared to the control group, children of physician parents were less likely to have a nonurgent final diagnosis: 33 versus 53%; relative risk (RR) 0.62 (95% confidence interval [CI] 0.44-0.87). Children with a nurse parent and children with an attorney parent were no more likely to present with a nonurgent diagnosis compared to control children: 49 versus 53%, RR 0.92 (95% CI 0.76-1.10) for children with a nurse parent and 45 versus 53%, RR 0.85 (95% CI 0.70-1.03) for children with an attorney parent.
Conclusions:
Children with a physician parent were less likely to use a pediatric ED for nonurgent problems compared to other children. However, children with a nurse parent, a group whose parents have more medical education than we can expect the general public to ever attain, had a pattern of pediatric ED utilization that was similar to the control children. These data suggest that improved parental education alone may not decrease ED use for conditions that could be managed in a less costly setting.