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Dall'Oglio I, Biagioli V, Pol A, Gawronski O, Carlin C, Cirulli L, Piga S, Stelitano R, Offidani C, Raucci U, Reale A, Tiozzo E, Villani A, Raponi M. Children accessing accident and emergency department for non-urgent consultations: A cross-sectional study about parents' use of primary care services. Int Emerg Nurs 2024; 74:101436. [PMID: 38744105 DOI: 10.1016/j.ienj.2024.101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Parents often take their children to the Paediatric Accident and Emergency Department (A&E) for non-urgent consultations rather than using community-based primary care services. This study describes the use of primary care services in parents taking their children to the A&E for non-urgent consultations. METHODS A cross-sectional study was conducted from July 2018 to June 2019, in a second-level Italian paediatric A&E of a tertiary-level children's academic research and hub hospital. Parents of children aged between 3 months and 6 years assigned with a white code at the triage were asked to complete a paper-and-pencil 40-item questionnaire after accessing the A&E for a non-urgent consultation. RESULTS The questionnaire was completed by the parents of 237 children (males 58 %; median age = 2.3 years). Overall, 48.1 % (n = 114) of the parents reported consulting 'often/always' the primary care paediatrician, mainly when their child was sick and for check-ups (n = 182, 76.8 %). However, only 7.2 % (n = 17) of the parents 'often/always' used any other health service in the community. Most of them (n = 191, 82 %) did not even know where the community health centre was located. CONCLUSION Parents accessing the A&E for non-urgent consultations should be better informed/educated on how to use community health services.
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Affiliation(s)
- Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Alessandra Pol
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Claudia Carlin
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Luisa Cirulli
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Simone Piga
- Unit of Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Rocco Stelitano
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Caterina Offidani
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Antonino Reale
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Alberto Villani
- Department of Emergency, Admissions, and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Massimiliano Raponi
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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Toriola E, Biviano L, Lau C, Hooke N, Donnelly A, Dickins E, Pengilly S, Ging J, Shaw N, Singh J. Advancing Pediatric Care: The virtualKIDS Experience in Nursing-Led Audio-Visual Clinical Services. Creat Nurs 2024; 30:118-124. [PMID: 38600876 DOI: 10.1177/10784535241245667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
During the COVID-19 pandemic, the escalating trend of pediatric patients, particularly non-urgent cases, going to the emergency departments (EDs) in New South Wales, Australia, prompted the establishment of virtualKIDS, a nursing-led telehealth service. This service, initiated in June 2021, operates 24/7 and provides comprehensive care through audio-visual consultations emphasizing a patient-centered approach. Three elements-COVID-19 Outpatient Response Team (CORT), virtualKIDS Acute Review (vKAR), and Virtual Urgent Care (VUC)-addressed specific needs during and beyond the pandemic, showcasing the adaptability and impact of virtual care. vKAR focuses on post-discharge support, allowing families access to telehealth for up to three days. Preliminary data indicates a 44% reduction in ED visits within 48 h. VUC employs nursing-led triaging paired with audiovisual assessment, demonstrating a 69% hospitalization avoidance rate. Hybrid ambulatory models such as a sleep study at home project, day-only tonsillectomies, and arthroscopic knee surgeries showcase innovative approaches to reducing hospital admissions and enhancing patient outcomes. This paper presents the evolution and diverse models of care implemented by the virtualKIDS service, offering insights into its potential as a nursing-led alternative to ED visits in acute-care pediatrics.
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Affiliation(s)
- Eunice Toriola
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Lyn Biviano
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Christine Lau
- Integrated Care Service, Sydney Children's Hospital Network
| | - Natalie Hooke
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Amie Donnelly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Emma Dickins
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Sandra Pengilly
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Joanne Ging
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Nadine Shaw
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
| | - Jagdev Singh
- virtualKIDS, Sydney Children's Hospital Network, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Pol A, Biagioli V, Adriani L, Fadda G, Gawronski O, Cirulli L, Stelitano R, Federici T, Tiozzo E, Dall'Oglio I. Non-urgent presentations to the paediatric emergency department: a literature review. Emerg Nurse 2023; 31:35-41. [PMID: 36727259 DOI: 10.7748/en.2023.e2154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
It is estimated that between 58% and 82% of children and young people who present to paediatric emergency department (PEDs) have a non-urgent condition. This systematic review of the literature explores why parents of children with non-urgent conditions present to the PED rather than to community healthcare services. Five databases were searched for studies on children and young people's presentations to the PED for the treatment of a non-urgent condition, as identified by a low priority triage code. This article describes and discusses the findings of the 18 included studies.
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Affiliation(s)
- Alessandra Pol
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Valentina Biagioli
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luca Adriani
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Giulia Fadda
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Orsola Gawronski
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Luisa Cirulli
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Rocco Stelitano
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Tatiana Federici
- paediatric emergency department, Bambino Gesù Children's Hospital in Rome, Italy
| | - Emanuela Tiozzo
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
| | - Immacolata Dall'Oglio
- professional development, continuing education and research service, Bambino Gesù Children's Hospital in Rome, Italy
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Quek SE, Seow C, Ganapathy S. Caregiver experiences in an Asian paediatric emergency department during the COVID-19 pandemic. Singapore Med J 2023:384041. [PMID: 37675668 DOI: 10.4103/singaporemedj.smj-2021-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Samuel Enci Quek
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Christopher Seow
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Sashikumar Ganapathy
- Department of Emergency Medicine, KK Women's and Children's Hospital; Duke-NUS Medical School, Singapore
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Simoens E, Michiels L, Toelen J, de Winter P. Navigating the unknown: understanding and managing parental anxiety when a child is ill. Arch Dis Child 2023:archdischild-2022-325220. [PMID: 36927621 DOI: 10.1136/archdischild-2022-325220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Parents are often confronted with a difficult decision when their child falls ill: should they go to the general practitioner (GP) or not? This study aims to describe this process comprehensively in order to allow clinicians to assess the extent to which parents can recognise clinical warning signs and act accordingly. The purpose of this study is to describe parents' decision-making processes when deciding whether or not to consult a GP for their sick child. METHODS We used a qualitative study design based on semistructured interviews to investigate the decision-making process of 25 parents. Four case scenarios describing a developing illness in a child were presented. RESULTS Parents' reasons for seeking medical attention could be divided into two main categories. First, non-specific fears lead parents to consult a doctor. Parents were alarmed by the persistence and progression of symptoms, the combination of symptoms or changes in their child's behaviour or they needed reassurance. Second, several specific fears were identified. Sometimes, parents fear a specific disease, while at other times, they are concerned about warning signs. Some parents, however, would not seek medical attention at any decision point even though their child could be in a potentially life-threatening situation. CONCLUSIONS Although parents make carefully considered decisions on whether or not to consult a doctor, many appear to miss red flags, including more experienced parents. Conversely, some become overly concerned with certain specific symptoms such as fever, and few parents are familiar with self-management strategies.
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Affiliation(s)
- Elise Simoens
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Lauren Michiels
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium
| | - Jaan Toelen
- Department of Pediatrics, KU Leuven University Hospitals, Leuven, Belgium.,Leuven Child and Health Institute, KU Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Peter de Winter
- Leuven Child and Health Institute, KU Leuven, Leuven, Belgium .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, The Netherlands
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McNeil S, McKie J, Parr M, Cheek J, Freed G, Meyer A, Craig S. Is this child suitable to be seen in primary care? Poor agreement between caregiver/family perception and definitions of a 'primary care-type' patient. J Paediatr Child Health 2023; 59:487-492. [PMID: 36655897 DOI: 10.1111/jpc.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
AIMS To compare and evaluate the number of paediatric patients classified as 'suitable for primary care' using the Australian Institute of Health and Welfare (AIHW) method, the Australasian College for Emergency Medicine (ACEM) method, and parental judgement. METHODS This was a prospective observational study enrolling parents/carers presenting with their children to two Victorian EDs in Victoria, Australia over a 1-week period. Trained research assistants were posted within both EDs and surveyed all eligible parents/carers whether they agreed with the statement 'I think a GP would be able to look after my child's current illness/injury'. Survey responses were linked to clinical outcomes and length of stay. Each presentation was classified as suitable for primary care using the AIHW method, the ACEM method and parental survey. Agreement between definitions was assessed using Cohen's kappa statistic. RESULTS During the study (June 2016), 1069 patients presented to the two EDs; 677 patients were able to be classified under all three definitions (AIHW: 1069, ACEM: 991, survey: 677 patients). Only 80/677 (12%) patients met all three criteria. Agreement was slight between the parent survey and the ACEM method (K = 0.14, 95% confidence interval (CI) 0.06-0.21), and the parent survey and the AIHW method (K = 0.12, 95% CI 0.05-0.19). There was moderate agreement between the ACEM and AIHW methods (K = 0.45, 95% CI 0.39-0.51). CONCLUSIONS There is very poor agreement on what defines a 'primary care-type' paediatric patient between the definitions used by government, professional bodies and caregivers.
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Affiliation(s)
- Scott McNeil
- Monash Emergency Research Collaborative, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jessica McKie
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Mandy Parr
- Paediatric Emergency Department, Monash Medical Centre, Emergency Program, Monash Health, Melbourne, Victoria, Australia
| | - John Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gary Freed
- University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Alastair Meyer
- Monash Emergency Research Collaborative, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Casey Hospital, Emergency Program, Monash Health, Melbourne, Victoria, Australia
| | - Simon Craig
- Monash Emergency Research Collaborative, Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Emergency Program, Monash Health, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Blakey SJ, Lyttle MD, Magnus D. Retrospective observational study of neonatal attendances to a children's emergency department. Acta Paediatr 2021; 110:2968-2975. [PMID: 34297856 DOI: 10.1111/apa.16039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
AIM Attendances to emergency departments (EDs) in the UK are increasing, particularly for younger children. Community services are under increasing pressure and parents may preferentially bring their babies to the ED, even for non-urgent problems. This study aimed to characterise the presenting features, management and disposition of neonatal attendances to a children's ED (CED). METHODS Retrospective observational review of neonatal attendances (≤28 days) to the CED at Bristol Royal Hospital for Children (BRHC) from 01/01/2016 to 31/12/2016. Further information was obtained from investigation results and discharge summaries. Data abstracted included sex, age, referral method, presenting complaint, diagnosis, investigations and treatments. RESULTS Neonatal attendances increased from 655 to 1,205 from 2008 to 2016. The most common presenting complaints were breathing difficulty (18.1%) and vomiting (8.3%). The most common diagnoses were 'no significant medical problem' (41.9%) and bronchiolitis (10.5%). Half of neonatal attendances to the CED had no investigations performed and most (77.7%) needed advice or observation only. CONCLUSION Many neonates presenting to the CED were well and discharged with observation only. This suggests potential for improving community management and in supporting new parents. Drivers of health policy should consider developing enhanced models of out of hospital care which are acceptable to clinicians and families.
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Affiliation(s)
- Sarah J. Blakey
- Emergency Department Bristol Royal Hospital for Children Bristol UK
| | - Mark D. Lyttle
- Emergency Department Bristol Royal Hospital for Children Bristol UK
- Faculty of Health and Applied Sciences University of the West of England Bristol UK
| | - Dan Magnus
- Emergency Department Bristol Royal Hospital for Children Bristol UK
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Nicholson E, McDonnell T, De Brún A, Barrett M, Bury G, Collins C, Hensey C, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare - systematic review. BMC Health Serv Res 2020; 20:663. [PMID: 32680518 PMCID: PMC7366445 DOI: 10.1186/s12913-020-05527-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Health systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion of healthcare delivery. A systematic review was conducted to establish the factors that influence parents' decision making when seeking unscheduled healthcare for their children. The systematic review question was "What are the factors that influence the decision making of parents and families seeking unscheduled paediatric healthcare?" METHOD Five databases (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and four grey literature databases (Proquest, Lenus, OpenGrey, Google Scholar) were searched. The titles and abstracts of 3746 articles were screened and full-text screening was performed on 177 of these articles. Fifty-six papers were selected for inclusion in the review. Data relating to different types of unscheduled health services (namely primary care, the emergency department and out-of-hours services) were extracted from these articles. A narrative approach was used to synthesise the extracted data. RESULTS Several factors were identified as influencing parental preferences and decision making when seeking unscheduled healthcare for their children. A number of the included studies identified pre-disposing factors such as race, ethnicity and socioeconomic status (SES) as impacting the healthcare-seeking behaviour of parents. Unscheduled healthcare use was often initiated by the parent's perception that the child's condition was urgent and their need for reassurance. The choice of unscheduled service was influenced by a myriad of factors such as: waiting times, availability of GP appointments, location of the ED, and the relationship that the parent or caregiver had with their GP. CONCLUSION Policy and planning initiatives do not always reflect how patients negotiate the health system as a single entity with numerous entry points. Altering patients' behaviour through public health initiatives that seek to improve, for instance, health literacy or reducing emergency hospital admissions through preventative primary care requires an understanding of the relative importance of factors that influence behaviour and decision making, and the interactions between these factors.
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Affiliation(s)
- E. Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - T. McDonnell
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - A. De Brún
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
| | - M. Barrett
- Department of Emergency Medicine/National Children’s Research Centre, Children’s Health Ireland at Crumlin, Dublin, Ireland
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - G. Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - C. Collins
- Irish College of General Practitioners, 4/5 Lincoln Place, Dublin 2, Ireland
| | - C. Hensey
- Children’s Health Ireland at Temple St, Temple St, Rotunda, Dublin 1, Ireland
| | - E. McAuliffe
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS) UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
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Ruzangi J, Blair M, Cecil E, Greenfield G, Bottle A, Hargreaves DS, Saxena S. Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017. BMJ Open 2020; 10:e033761. [PMID: 32371509 PMCID: PMC7228511 DOI: 10.1136/bmjopen-2019-033761] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017 DESIGN: Population-based retrospective cohort study. METHODS We used linked data from the Clinical Practice Research Datalink to study children's primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists. RESULTS Between 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (-1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017. CONCLUSIONS Over the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children's use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.
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Affiliation(s)
- Judith Ruzangi
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Elizabeth Cecil
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Geva Greenfield
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Alex Bottle
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care & Public Health, Imperial College London, London, UK
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O’Cathain A, Knowles E, Long J, Connell J, Bishop-Edwards L, Simpson R, Coster J, Abouzeid L, Bennett S, Croot E, Dickson JM, Goodacre S, Hirst E, Jacques R, Phillips M, Turnbull J, Turner J. Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
There is widespread concern about the pressure on emergency and urgent services in the UK, particularly emergency ambulances, emergency departments and same-day general practitioner appointments. A mismatch between supply and demand has led to interest in what can be termed ‘clinically unnecessary’ use of services. This is defined by the research team in this study as ‘patients attending services with problems that are classified as suitable for treatment by a lower urgency service or self-care’. This is a challenging issue to consider because patients may face difficulties when deciding the best action to take, and different staff may make different judgements about what constitutes a legitimate reason for service use.
Objectives
To identify the drivers of ‘clinically unnecessary’ use of emergency ambulances, emergency departments and same-day general practitioner appointments from patient and population perspectives.
Design
This was a sequential mixed-methods study with three components: a realist review; qualitative interviews (n = 48) and focus groups (n = 3) with patients considered ‘clinically unnecessary’ users of these services, focusing on parents of young children, young adults and people in areas of social deprivation; and a population survey (n = 2906) to explore attitudes towards seeking care for unexpected, non-life-threatening health problems and to identify the characteristics of someone with a tendency for ‘clinically unnecessary’ help-seeking.
Results
From the results of the three study components, we found that multiple, interacting drivers influenced individuals’ decision-making. Drivers could be grouped into symptom related, patient related and health service related. Symptom-related drivers were anxiety or need for reassurance, which were caused by uncertainty about the meaning or seriousness of symptoms; concern about the impact of symptoms on daily activities/functioning; and a need for immediate relief of intolerable symptoms, particularly pain. Patient-related drivers were reduced coping capacity as a result of illness, stress or limited resources; fear of consequences when responsible for another person’s health, particularly a child; and the influence of social networks. Health service-related drivers were perceptions or previous experiences of services, particularly the attractions of emergency departments; a lack of timely access to an appropriate general practitioner appointment; and compliance with health service staff’s advice.
Limitations
Difficulty recruiting patients who had used the ambulance service to the interviews and focus groups meant that we were not able to add as much as we had anticipated to the limited evidence base regarding this service.
Conclusions
Patients use emergency ambulances, emergency departments and same-day general practitioner appointments when they may not need the level of clinical care provided by these services for a multitude of inter-related reasons that sometimes differ by population subgroup. Some of these reasons relate to health services, in terms of difficulty accessing general practice leading to use of emergency departments, and to population-learnt behaviour concerning the positive attributes of emergency departments, rather than to patient characteristics. Social circumstances, such as complex and stressful lives, influence help-seeking for all three services. Demand may be ‘clinically unnecessary’ but completely understandable when service accessibility and patients’ social circumstances are considered.
Future work
There is a need to evaluate interventions, including changing service configuration, strengthening general practice and addressing the stressors that have an impact on people’s coping capacity. Different subgroups may require different interventions.
Study registration
This study is registered as PROSPERO CRD42017056273.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jaqui Long
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Rebecca Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Elizabeth Croot
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon M Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Enid Hirst
- Sheffield Emergency Care Forum, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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O'Cathain A, Connell J, Long J, Coster J. 'Clinically unnecessary' use of emergency and urgent care: A realist review of patients' decision making. Health Expect 2019; 23:19-40. [PMID: 31663219 PMCID: PMC6978874 DOI: 10.1111/hex.12995] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 01/28/2023] Open
Abstract
Background Demand is labelled ‘clinically unnecessary’ when patients do not need the levels of clinical care or urgency provided by the service they contact. Objective To identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged as clinically unnecessary. Design Realist review. Methods Papers from four recent systematic reviews of demand for emergency and urgent care, and an updated search to January 2017. Programme theories developed using Context‐Mechanism‐Outcome chains identified from 32 qualitative studies and tested by exploring their relationship with existing health behaviour theories and 29 quantitative studies. Results Six mechanisms, based on ten interrelated programme theories, explained why patients made clinically unnecessary use of emergency and urgent care: (a) need for risk minimization, for example heightened anxiety due to previous experiences of traumatic events; (b) need for speed, for example caused by need to function normally to attend to responsibilities; (c) need for low treatment‐seeking burden, caused by inability to cope due to complex or stressful lives; (d) compliance, because family or health services had advised such action; (e) consumer satisfaction, because emergency departments were perceived to offer the desired tests and expertise when contrasted with primary care; and (f) frustration, where patients had attempted and failed to obtain a general practitioner appointment in the desired timeframe. Multiple mechanisms could operate for an individual. Conclusions Rather than only focusing on individuals' behaviour, interventions could include changes to health service configuration and accessibility, and societal changes to increase coping ability.
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Affiliation(s)
- Alicia O'Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jaqui Long
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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12
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Turnbull J, McKenna G, Prichard J, Rogers A, Crouch R, Lennon A, Pope C. Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Gemma McKenna
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, University of Southampton, Southampton, UK
| | - Robert Crouch
- Emergency Department, University Hospital Southampton NHS Foundation Trust (UHS), Southampton, UK
| | - Andrew Lennon
- Southern Headquarters, South Central Ambulance Service NHS Foundation Trust (SCAS), Winchester, UK
| | - Catherine Pope
- School of Health Sciences, University of Southampton, Southampton, UK
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Keizer E, Christensen MB, Carlsen AH, Smits M, Wensing M, Senn O, Huibers L. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. BMC Public Health 2019; 19:33. [PMID: 30621741 PMCID: PMC6323727 DOI: 10.1186/s12889-018-6332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background The acute out-of-hours healthcare services are challenged by increasing demand in many countries. We aimed to examine factors influencing the intended help-seeking in out-of-hours care for acute health problems during evenings, nights, and weekends. Methods We conducted a survey study based on data from parents of children (aged 0–4 years) and adults (aged 30–39 and 50–59 years) in Denmark, the Netherlands and Switzerland. Intended help-seeking behaviour was measured by six hypothetical case scenarios. We used Andersen’s Behavioural Model to categorise potentially influential factors and applied multiple binomial regression to assess the influence of selected factors. Results A total of 1015 parents and 2942 adults participated. We identified several significant influential factors. Parents holding a low education (OR 1.56), having migrant background (western: OR 1.23; non-western: OR 1.93), having one child (OR 1.24), perceiving few barriers to using out-of-hours primary care (OR 1.59), perceiving difficulties with organising childcare (OR 1.13), and having a history of frequent contacts with out-of-hours care (OR 1.55) were more inclined to contact out-of-hours care, whereas female (OR 0.85) and non-anxious parents (OR 0.77) were less inclined. Adults who were older (OR 1.01), holding a medical education (OR 1.13), having non-western background (OR 1.28), being unemployed (OR 1.17), perceiving few barriers to using out-of-hours primary care (OR 1.37), and having a history of frequent contacts with a GP (few: OR 1.15; more: OR 1.22) and/or with out-of-hours care (one: OR 1.20; more: OR 1.49) were more inclined to contact out-of-hours care, whereas adults with no or little social support (OR 0.84) and adults with high health literacy level on health information (OR 0.91) were less inclined. Dutch parents were less inclined than Danish parents to contact out-of-hours care (OR 0.62), whereas Swiss adults were more inclined than Danish adults to contact out-of-hours care (OR 1.16). Conclusion We identified several factors related to intended help-seeking in out-of-hours care. These results could be used to develop targeted interventions, but more research is needed to examine the underlying explanations for the identified differences. Electronic supplementary material The online version of this article (10.1186/s12889-018-6332-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | | | - Anders Helles Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Linda Huibers
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
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Canévet JP, Bourgogne C, Querbès B, Jourdain M, Vrignaud B, Gras-Leguen C. Recours inappropriés aux urgences pédiatriques par les parents : approche qualitative d'un comportement multidimensionnel. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Les recours aux services d'urgences pédiatriques se multiplient, mais une partie d'entre eux sont médicalement inappropriés. Pour comprendre, au-delà des déterminants connus comme la démographie médicale ou l'attraction du plateau technique, la genèse de ces recours inadéquats et les logiques internes des parents concernés, une enquête a été menée en Pays de la Loire.
Méthode : Qualitative par entretiens semi-directifs, à Nantes et à La Roche-sur-Yon, auprès de parents ayant conduit leur enfant aux urgences et qui, après examen clinique, n'a eu besoin ni de soin ni d'investigation technique. Les entretiens étaient centrés sur le récit de l'épisode ayant motivé la décision de recours et sur le contexte familial de cette décision. Une analyse thématique puis conceptuelle a tenté d'aboutir à une typologie de recours.
Résultats : Les thèmes récurrents permettant d'interpréter ces recours concernaient : 1) le niveau d'inquiétude lié au caractère inhabituel ou inexplicable des premiers symptômes ; 2) la grande confiance accordée aux services d'urgences, effaçant tous les inconvénients possibles ; 3) une perception contrastée ou une méconnaissance du réseau de soins primaires freinant son usage non programmé. Des thèmes discordants concernant le contexte familial ont permis d'isoler trois modalités de recours inappropriés : recours par effacement parental et délégation de responsabilité de la part de parents se positionnant comme profanes incompétents, recours par confrontation de compétence avec revendication de reconnaissance de l'expertise parentale, recours par recherche de complémentarité de compétence avec les médecins.
Conclusion : Certains recours inappropriés peuvent cacher une demande implicite d'étayage urgent de la parentalité.
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Curran J, Cassidy C, Chiasson D, MacPhee S, Bishop A. Patient and caregiver expectations of emergency department care: A scoping literature review. Int Emerg Nurs 2017; 32:62-69. [DOI: 10.1016/j.ienj.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/04/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
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Cheek JA, Braitberg G, Craig S, West A. Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department. J Paediatr Child Health 2017; 53:451-457. [PMID: 28195435 DOI: 10.1111/jpc.13482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
AIM To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define 'primary care suitable' presentations to the ED. METHODS A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. RESULTS There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3-61.4%) presentations were judged as 'ED appropriate' by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered 'primary care suitable', ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians' opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). CONCLUSIONS We caution that many strategies attempting to 'solve' the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs.
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Affiliation(s)
- John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - George Braitberg
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Craig
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Monash Emergency Research Collaborative, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Paediatric Emergency Department, Monash Children's Hospital, Melbourne, Victoria, Australia
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17
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Gnani S, Morton S, Ramzan F, Davison M, Ladbrooke T, Majeed A, Saxena S. Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study. BMJ Open 2016; 6:e010672. [PMID: 27288373 PMCID: PMC4908914 DOI: 10.1136/bmjopen-2015-010672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Urgent care centres' (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in 2 general practitioner (GP)-led UCCs with extended opening times. DESIGN Retrospective observational epidemiological study using routinely collected data. SETTING 2 GP-led UCCs in London, colocated with a hospital ED. PARTICIPANTS All children aged under 5 years, attending 2 GP-led UCCs over a 3-year period. OUTCOMES Outcomes of care for the children including: primary diagnosis; registration status with a GP; destination following review within the UCC; and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made. RESULTS 3% (n=7747/282 947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP, and over two-thirds of attendances were 'out of hours'. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% CI 8.9 to 10.0). CONCLUSIONS Two-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.
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Affiliation(s)
- S Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - S Morton
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - F Ramzan
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - M Davison
- North End Medical Centre, London, UK
| | - T Ladbrooke
- London Central and West Unscheduled Care Collaborative, London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - S Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Ogilvie S, Hopgood K, Higginson I, Ives A, Smith JE. Why do parents use the emergency department for minor injury and illness? A cross-sectional questionnaire. JRSM Open 2016; 7:2054270415623695. [PMID: 26981256 PMCID: PMC4780204 DOI: 10.1177/2054270415623695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To understand decision-making when bringing a child to an emergency department. Design A cross-sectional survey of parents attending with children allocated a minor triage category. Setting Emergency department in South West England, serving 450,000 people per annum. Participants All English-speaking parents/caregivers whose children attended the emergency department and were triaged as minor injury/illness. Main outcome measures Parental and child characteristics, injury/illness characteristics, advice seeking behaviour, views regarding emergency department service improvement, GP access and determinants of emergency department use. Results In sum, 373 responses were analysed. The majority of attendances were for minor injury, although illness was more common in <4 year olds. Most presentations were within 4 h of injury/illness and parents typically sought advice before attending. Younger parents reported feeling more stressed. Parents of younger children perceived the injury/illness to be more serious, reporting greater levels of worry, stress, helplessness and upset and less confidence. Parents educated to a higher level were more likely to administer first-aid/medication. Around 40% did not seek advice prior to attending and typically these were parents aged <24 and parents of <1 year olds. The main determinants of use were: advised by someone other than a GP; perceived urgency; perceived appropriateness. The need for reassurance also featured. Conclusions The findings suggest that it is difficult for parents to determine whether their child’s symptoms reflect minor conditions. Efforts should focus on building parental confidence and self-help and be directed at parents of younger children and younger parents. This is in addition to appropriate minor injury/illness assessment and treatment services.
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Affiliation(s)
- Sarah Ogilvie
- Specialty Registrar in Public Health, Office of the Director of Public Health, Plymouth City Council, Plymouth PL6 8DH, UK
| | - Katie Hopgood
- Specialty Registrar in Public Health, Office of the Director of Public Health, Plymouth City Council, Plymouth PL6 8DH, UK
| | - Ian Higginson
- Consultant in Emergency Medicine, Emergency Department, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK
| | - Andrew Ives
- Consultant Paediatrician, Department of Paediatrics, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK
| | - Jason E Smith
- Consultant in Emergency Medicine, Emergency Department, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK
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Meehan E, Reid SM, Williams K, Freed GL, Babl FE, Sewell JR, Rawicki B, Reddihough DS. Tertiary paediatric emergency department use in children and young people with cerebral palsy. J Paediatr Child Health 2015; 51:994-1000. [PMID: 25976361 DOI: 10.1111/jpc.12919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to describe the pattern of tertiary paediatric emergency department (ED) use in children and young people with cerebral palsy (CP). METHODS A retrospective analysis of ED data routinely collected at the two tertiary paediatric hospitals in Victoria, Australia, cross-matched with the Victorian Cerebral Palsy Register. Data pertaining to the ED presentations of 2183 registered individuals born 1993-2008 were obtained. RESULTS Between 2008 and 2012, 37% (n = 814) of the CP cohort had 3631 tertiary paediatric ED presentations. Overall, 40% (n = 332) of presenters were residing in inner metropolitan Melbourne; 44% (n = 356) in outer Melbourne; and 13% (n = 108) in regional Victoria. Presenters were more likely than non-presenters to be younger, non-ambulant and have epilepsy. In total, 71% of presentations were triaged as Australasian Triage Scale 1-3 (urgent), and 44% resulted in a hospital admission. Disorders of the respiratory, neurological and gastrointestinal systems, and medical device problems were responsible for 72% of presentations. CONCLUSION Many of the tertiary paediatric ED presentations in this group were appropriate based on the high admission rate and the large proportion triaged as urgent. However, there is evidence that some families are bypassing local services and travelling long distances to attend the tertiary paediatric ED, even for less urgent complaints that do not require hospital admission. Alternative pathways of care delivery, and strategies to promote the management of common problems experienced by children and young people with CP in non-paediatric EDs or primary care settings, may go some way towards reducing unnecessary tertiary paediatric ED use in this group.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Susan M Reid
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Global and Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jillian R Sewell
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Policy, Equity and Translation Research, Population Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Barry Rawicki
- Paediatric Rehabilitation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Dinah S Reddihough
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Developmental Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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20
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Freed GL, Bingham A, Allen AR, Freed M, Sanci LA, Spike N. Actual availability of general practice appointments for mildly ill children. Med J Aust 2015. [DOI: 10.5694/mja14.01724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Batu ED, Yeni S, Teksam O. The Factors Affecting Neonatal Presentations to the Pediatric Emergency Department. J Emerg Med 2015; 48:542-7. [DOI: 10.1016/j.jemermed.2014.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 12/01/2014] [Accepted: 12/21/2014] [Indexed: 11/24/2022]
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Freed GL, Gafforini S, Carson N. Age distribution of emergency department presentations in Victoria. Emerg Med Australas 2015; 27:102-7. [PMID: 25690308 DOI: 10.1111/1742-6723.12368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patterns of ED utilisation over time, by patient age group and triage classification. METHODS Secondary analysis of data from all patients presenting to EDs in Victoria utilising the Victorian Emergency Minimum Dataset (VEMD) for the years 2002-2013. The VEMD includes all hospitals in Victoria with 24 h EDs. RESULTS The absolute number of presentations to EDs in Victoria has grown by over 52% in the last 11 years. The triage categories of highest urgency (1-3) grew by 89% whereas the categories of lowest urgency (4-5) grew by 33%. Over this period, the 5 year age band with the greatest number of ED presentations has consistently been, by far, children 0-4 years of age. This age group has seen an increase of 29% in ED presentations overall with a >55% increase in Triage 1-3, and an increase of 16% in triage 4-5. For all age groups, there has been little change in the number of triage category 4-5 presentations since 2007/2008. However, for triage categories 1-3, there have been consistent increases in presentations across all age groups. CONCLUSION The age range with the greatest absolute number of ED presentations in Victoria is children 0-4 years of age. This finding is consistent over time and across all triage classifications. The age range with the second highest absolute number of ED presentations is comprised of those 20-24 years of age. This is in contrast to the frequent public attention placed on the volume of ED presentations by the elderly.
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Affiliation(s)
- Gary L Freed
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Rati RMS, Goulart LMHDF, Alvim CG, Mota JAC. ["Children cannot wait": why mothers seek urgency and emergency care services for their children in non-urgent situations]. CIENCIA & SAUDE COLETIVA 2013; 18:3663-72. [PMID: 24263882 DOI: 10.1590/s1413-81232013001200022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/25/2012] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to seek to understand the reasons why mothers seek urgency and emergency attention for children in non-urgent situations in a public hospital of the Unified Health System in Belo Horizonte in the state of Minas Gerais. It is a study involving a qualitative approach with semi-structured interviews as the data collection tool. Twenty-seven mothers of children with complaints classified as minor and non-urgent were interviewed. Fever and respiratory problems were found to be the main complaints. Even when the situation is non-urgent, mothers take their children to the emergency service because of the swift resolution, quality and specific pediatric medical care advantages, ease of access, previous experiences and recommendations from others, among other reasons. The statements revealed the mismatch between these mothers' feelings and the rationale of the organization of the service. This work raises questions that can provide input for reflection on the organization of the services centered on the users, who are in the final analysis the subject and scope of the care-giving process.
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Duncan C, Williams K, Nathanson D, Thomas S, Cottier C, O'Meara M, Zwi K. Emergency department presentations by Aboriginal children: issues for consideration for appropriate health services. J Paediatr Child Health 2013; 49:E448-50. [PMID: 23692582 DOI: 10.1111/jpc.12225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/28/2022]
Abstract
AIM This study describes the presentations made to the Sydney Children's Hospital (SCH) Emergency Department (ED) by local Aboriginal and Torres Strait Islander (Aboriginal) children with particular reference to children who present frequently or whose presentation was preventable. METHODS Data from the SCH ED Information System were extracted for all presentations made by children who identified as Aboriginal, aged between 0-15 years, who presented between 2005-2008. Presentations were coded according to the presenting problem, diagnosis, outcome, and whether the presentations were potentially preventable. Preventable presentations include those presentations considered to be avoidable and those that could have been managed by a local primary care or community service. RESULTS There were 1252 presentations to the SCH ED by 453 Aboriginal children aged 0-15 years. More than 50% of children presented more than once. Seventy-nine children presented more than five times. Nearly 45% of presentations were coded as potentially preventable. CONCLUSIONS A significant proportion of ED presentations were potentially preventable with the use of culturally appropriate and accessible local community and primary health care services and better referral pathways back to these services. Community engagement is required to raise awareness of common presentations and to look at strategies to prevent common problems both occurring and presenting to the ED. This will enhance the health of urban Aboriginal children.
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Affiliation(s)
- Catriona Duncan
- Department of Community Child Health, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Costa ADPVD, Silva GAPD. Indicação da Terapia de Reidratação Oral no setor de emergência: decisão baseada na clínica? REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000200014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Revisar a literatura acerca da indicação da terapia de reidratação oral (TRO) no contexto do Setor de Emergência, buscando fatores inerentes à formação do médico, à atitude do cuidador e, finalmente, à dinâmica do próprio serviço como determinantes à sua aplicação. FONTES DE DADOS: Revisão não-sistemática da literatura incluindo artigos originais e meta-análises, nos idiomas inglês, português e espanhol, a partir das bases de dados Pubmed/Medline, Cochrane Collaboration, Lilacs e SciELO, no período de 1990 a 2008. Foram utilizados os termos "oral rehydration therapy", "diarrhea case management", "emergency department" e palavras relacionadas. SÍNTESE DOS DADOS: Realizada em local apropriado, a TRO mostrou eficácia semelhante à terapia venosa no restabelecimento do nível de hidratação em crianças com diarreia aguda no Setor de Emergência. O tempo de formado e a experiência profissional, o conhecimento e o treinamento no manejo da diarreia aguda mostraram associação à utilização da TRO. Entretanto, relatos de inconveniência de sua administração no Setor de Emergência incluem falta de espaço físico e pressão assistencial, sugerindo, ao mesmo tempo, inadequação estrutural e uso inapropriado do serviço nesses casos. A relação com o cuidador também influencia na decisão médica, com o relato de desconfiança deste quanto à eficácia da terapia sendo citado como barreira à sua indicação. CONCLUSÕES: A subutilização da TRO no Setor de Emergência está associada a fatores extrínsecos à formação médica, como questões estruturais e fatores inerentes à relação com o cuidador diante das suas expectativas quanto à terapia.
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Kroner EL, Hoffmann RG, Brousseau DC. Emergency department reliance: a discriminatory measure of frequent emergency department users. Pediatrics 2010; 125:133-8. [PMID: 20008418 DOI: 10.1542/peds.2009-0960] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE High emergency department (ED) use has previously been defined as a person's having a large number of ED visits, implying that all frequent users are the same. ED reliance (EDR), the percentage of all health care visits that occur in the ED, considers ED use in relation to primary care use and, thus, may discriminate among high-ED-user populations. Our objective was to determine whether EDR, as a complementary use measure, could differentiate frequent users secondary to increased need for care from those with access issues. METHODS We conducted an analysis of prospectively collected data from the Medical Expenditure Panel Survey from 2000-2001 and 2001-2002. Frequent ED users were defined as having >or=2 ED visits, and EDR was dichotomized as high (>0.33) or low (<or=0.33). Odds of being a frequent user or having high EDR were analyzed by using logistic regression. RESULTS A total of 8823 children were included. Within frequent-ED-use populations, young children and children with special health care needs were less likely (odds ratio: 0.55 and 0.72, respectively) to have high EDR, whereas those with lower education, low income, and public insurance and those of black race were more likely to have high EDR. CONCLUSIONS EDR is a readily available measure in large administrative databases that discriminates among frequent-user populations, differentiating increased need for ED services from lack of access to quality primary care.
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Affiliation(s)
- Eric L Kroner
- Section of Emergency Medicine, Department of Pediatrics, Children's Research Institute, Milwaukee, Wisconsin 53226, USA.
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Pediatric Emergency Department Overcrowding: Electronic Medical Record for Identification of Frequent, Lower Acuity Visitors. Can We Effectively Identify Patients for Enhanced Resource Utilization? J Emerg Med 2009; 36:311-6. [DOI: 10.1016/j.jemermed.2007.10.090] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 10/10/2007] [Accepted: 10/23/2007] [Indexed: 11/19/2022]
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Jackson C, Cheater FM, Reid I. A systematic review of decision support needs of parents making child health decisions. Health Expect 2008; 11:232-51. [PMID: 18816320 DOI: 10.1111/j.1369-7625.2008.00496.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify the decision support needs of parents attempting to make an informed health decision on behalf of a child. CONTEXT The first step towards implementing patient decision support is to assess patients' information and decision-making needs. SEARCH STRATEGY A systematic search of key bibliographic databases for decision support studies was performed in 2005. Reference lists of relevant review articles and key authors were searched. Three relevant journals were hand searched. INCLUSION CRITERIA Non-intervention studies containing data on decision support needs of parents making child health decisions. DATA EXTRACTION AND SYNTHESIS Data were extracted on study characteristics, decision focus and decision support needs. Studies were quality assessed using a pre-defined set of criteria. Data synthesis used the UK Evidence for Policy and Practice Information and Co-ordinating Centre approach. MAIN RESULTS One-hundred and forty nine studies were included across various child health decisions, settings and study designs. Thematic analysis of decision support needs indicated three key issues: (i) information (including suggestions about the content, delivery, source, timing); (ii) talking to others (including concerns about pressure from others); and (iii) feeling a sense of control over the process that could be influenced by emotionally charged decisions, the consultation process, and structural or service barriers. These were consistent across decision type, study design and whether or not the study focused on informed decision making.
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Affiliation(s)
- Cath Jackson
- School of Healthcare, University of Leeds, Leeds, UK.
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Abstract
AIMS To investigate the characteristics of neonates presenting to a metropolitan Mixed Emergency Department (MED). To examine whether there are maternal and neonatal characteristics which increase the risk of presentation to the ED in the neonatal period. METHODS A retrospective chart review was performed of all neonatal presentations occurring between July 2002 and June 2003 to Liverpool Hospital Emergency Department, a Level 6 MED located in south-western Sydney, New South Wales, Australia, seeing approximately 45,000 presentations annually of which 20% are paediatric. Comparisons of maternal and neonatal characteristics were made with Liverpool Hospital, Area Health Service and New South Wales Mothers and Babies data, and with other paediatric presentations to the MED. RESULTS 179 neonates made 194 neonatal presentations. Compared with all paediatric presentations, the neonatal triage category assignment, admission and transfer proportions were significantly higher, although just over half had 'primary care type illnesses'. Mothers of neonates presenting to this MED were more likely to be younger and first time mothers in comparison to the general population of mothers and newborns. This study did not find an over-representation of neonates who were discharged within 48 h after birth. CONCLUSION The implications of these results for practice include a consideration of the availability and appropriateness of after-hours service available to new mothers. Further studies investigating parental reasons for neonatal ED presentation are recommended.
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Affiliation(s)
- Setthy Ung
- Liverpool Hospital, Sydney, NSW, Australia
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Ryan M, Spicer M, Hyett C, Barnett P. Non-urgent presentations to a paediatric emergency department: parental behaviours, expectations and outcomes. Emerg Med Australas 2006; 17:457-62. [PMID: 16302938 DOI: 10.1111/j.1742-6723.2005.00777.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify factors that influence the attendance of children with non-urgent medical problems to a tertiary paediatric ED and to define parental expectations of the hospital visit. METHODS A questionnaire administered to a convenience sample of 200 parents/carers who attended the paediatric ED and whose children were categorized as having non-urgent problems that had been present for at least 4 weeks. Subsequent outpatient attendances were then analysed retrospectively. RESULTS Most patients had visited a general practitioner but remained unhappy with the outcome of the consultation. The hospital was expected to provide immediate diagnosis and initiate appropriate treatment by the vast majority of parent. Only four patients required admission. CONCLUSIONS The expectations of parents who attend the paediatric ED with children who have non-urgent chronic complaints are high. Rapid access to outpatient clinics might provide an acceptable alternative for these patients, and free valuable ED resources.
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Affiliation(s)
- Mary Ryan
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Abstract
OBJECTIVE To determine the factors associated with nonacute presentation to the emergency department (ED) by infants less than 14 days of age. METHODS A prospective survey was conducted in the pediatric ED of a teaching hospital providing voluntary in-home follow-up for families discharged within 48 hours of delivery. Participants were families of infants less than 14 days of age presenting to the ED over a 1-year period. The main outcome measure was acuteness of presenting problem. Presenting problems were classified as nonacute if the following 4 criteria were met: (i) no physician referral; (ii) nonurgent triage code assigned by a triage nurse; (iii) no investigations performed in the ED; and (iv) discharge home. RESULTS Of the 142 eligible infants, 70 (49%) infants presented with nonacute problems. Ninety-two (65%) returned questionnaires. There was no significant difference in the proportion of nonacute problems between infants discharged at less than 48 hours of age and those discharged at more than 48 hours (P = 0.7). The proportion of nonacute problems among infants of primiparous mothers was significantly higher (64%) than among infants of multiparous mothers (24%) (P < 0.001). Infants of mothers less than 25 years of age were more likely to present with nonacute problems (P = 0.002). CONCLUSIONS Primiparity and maternal age less than 25 years were associated with nonacute ED presentation. Acuteness of presentation to the ED was not influenced by timing of neonatal discharge. Therefore, perinatal education might be best targeted at first time mothers and young mothers to reduce the number of nonacute ED visits.
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Affiliation(s)
- T J T Kennedy
- Department of Pediatrics, Dalhousie University and IWK Grace Health Centre, Halifax, Nova Scotia
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Cooper C, Simpson JM, Hanson R. The district hospital emergency department: Why do parents present? EMERGENCY MEDICINE (FREMANTLE, W.A.) 2003; 15:68-76. [PMID: 12656790 DOI: 10.1046/j.1442-2026.2003.00411.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify parental reasons for presenting their child to the emergency department and their expectations of the consultation. METHOD Cross-sectional survey of parents of children and adolescents aged 14 years and under who presented to the Fairfield Emergency Department over a 2-month period. RESULTS A questionnaire was returned from 694 of 839 eligible presentations (83%), with 51% having an urgent triage and 26% being admitted. Proximity was nominated as the reason for choosing the Fairfield Emergency Department by 48%, 62% of presentations were self-referred and 44% had already seen another doctor. An urgent triage was associated with parental expectation of admission or observation in the emergency department (OR 2.79 [95% CI: 1.98-3.94]). CONCLUSIONS The majority of presentations to the district emergency department are self-referred and it is chosen because of proximity. The majority of children do not require admission; however, parents often have expectations that observation and further investigation will occur prior to discharge from the emergency department.
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Affiliation(s)
- Carolyn Cooper
- Fairfield Health Service, Fairfield, Department of Public Health and Community Medicine, University of Sydney, Sydney, Australia.
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Bridges J, Hanson R, Little M, Flannigan AC, Fairley M, Haywood L. Ethical relationships in paediatric emergency medicine: moving beyond the dyad. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2001; 13:344-50. [PMID: 11554867 DOI: 10.1046/j.1035-6851.2001.00238.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Most areas of health-services research concentrate on a dyadic relationship between doctor and patient. In paediatric emergency medicine it may be necessary to focus on a more complicated relationship because the parents of the child play an important role in the delivery of medical services. This paper discusses the ethical principles in paediatric emergency medicine from the perspective of five disciplines: health economics, paediatrics, medical ethics, law and mental health. The general consensus is that the traditional dyadic model is inadequate and that a more complicated relationship is needed for the paediatric emergency setting, such as triadic, multiple-dyadic or polyadic. Such models allow the inclusion of the parents and possibly other family members, medical providers and community members. If the paediatric setting is considered in such a framework, it may be possible to deliver a more socially beneficial medical service.
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Affiliation(s)
- J Bridges
- Department of Economics, Case Western Reserve University, Cleveland, Ohio 44106-7206, United States of America.
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