Elsevier

Ambulatory Pediatrics

Volume 8, Issue 6, November–December 2008, Pages 360-367
Ambulatory Pediatrics

Pediatric Emergency Medicine
Why Do Parents Bring Children to the Emergency Department for Nonurgent Conditions? A Qualitative Study

https://doi.org/10.1016/j.ambp.2008.07.001Get rights and content

Objective

Nonurgent conditions account for 58% to 82% of pediatric emergency department (ED) visits, but only 1 preliminary qualitative study has examined reasons why parents bring children to the ED for nonurgent care. The aim of this study was to identify parents’ reasons for choosing the ED over their primary care provider (PCP) for nonurgent pediatric care.

Methods

Audiotaped ethnographic interviews in English and Spanish were conducted of parents of children presenting for nonurgent care on weekdays from 8 AM to 4 PM at a children's hospital ED over a 4-week period.

Results

For the 31 families interviewed, the mean parental age was 28 years, and mean child age, 3 years. Reasons cited by caregivers for choosing the ED over their child's PCP were long appointment waits, dissatisfaction with the PCP, communication problems (accents and unhelpful staff at PCP), health care provider referral, efficiency, ED resources, convenience, quality of care, and ED expertise with children. Some parents said they would like education on the urgency of pediatric problems.

Conclusions

Parents bring their children to the ED for nonurgent care because of problems with their PCP, PCP referral, and perceived advantages to ED care. Although parents report that education on the urgency of pediatric conditions would be helpful, substantial reduction of pediatric nonurgent ED use may require improvements in families’ PCP office access, efficiency, experiences, and appointment scheduling.

Section snippets

Methods

Ethnographic interviews were conducted over a 4-week period in June to July 2005 with a consecutive series of caregivers (henceforth referred to as “parents”) of children presenting for care to the ED of the Children's Hospital of Wisconsin, which serves a combined urban/suburban population with 55 000 visits per year. Parents were eligible to participate if they brought their child to the ED for care during hours when physicians’ offices are routinely open (Monday to Friday, 8 AM to 4 PM) and

Results

Fifty-four eligible families were identified during the study period (Figure). Nine of these left the ED prior to being asked to participate in the study. Of the 45 eligible families who were approached, 12 chose not to participate. Thirty-one interviews were completed and audiotaped.

The 31 completed interviews involved 37 caregivers and 34 children (Table 2), since some children were accompanied by more than 1 caregiver, and some families brought more than 1 child to the ED. Caregivers

Discussion

To reduce nonurgent pediatric ED use and ensure that all children receive high-quality primary care, it is imperative to understand parents’ reasons for choosing the ED over primary care practices for nonurgent pediatric care. In fact, a previous study documents that attempts to decrease nonurgent ED use by simply diverting children to their PCP were unsuccessful in altering future behavior, potentially because the underlying concerns of parents were not addressed.30 Our study findings indicate

Conclusions

Parents bring their children to EDs for nonurgent care because of PCP referral, efficiency, dissatisfaction with PCPs, perceived higher quality of care in the ED, long waits to see PCPs, and PCP communication problems. Although parents report that education on the urgency of pediatric conditions would be helpful, substantial reduction of pediatric nonurgent ED use may require improvements in families’ PCP office access, efficiency, experiences, and appointment scheduling.

Acknowledgment

This study was supported by a grant to A.B. and G.F. from the APS/SPR Summer Student Research Program (2 T-35 grant HD 007446) and in part by a grant from the Robert Wood Johnson Physician Faculty Scholars Program to J.M.B.

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