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APHA Scientific Session and Event Listing

Recorded presentation

Anne M. Berry¹, David C. Brousseau, MD², Jane Brotanek, MD³, Sandra C. Tomany-Korman, MS³, and Glenn Flores, MD³. (1) Penn State College of Medicine, 321 University Manor West, Hershey, PA 17033, 717-531-7880, aberry@psu.edu, (2) Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Avenue - MS 677, Milwaukee, WI 53226, (3) Center for the Advancement of Underserved Children, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226

Background – Emergency department (ED) use increased 20% from 1992 - 2001, with children comprising ¼ of all ED visits, or 22 million visits per year. 58-82% of pediatric ED visits are for nonurgent conditions. Demographic characteristics of families using the ED for pediatric nonurgent conditions are well described, but the reasons parents seek this care in the ED have not been identified, and no published qualitative research has examined this issue.

Objective – To determine why families use the ED for nonurgent pediatric care by identifying parents' reasons for choosing the ED over primary care.

Methods – Audiotaped ethnographic interviews in English and Spanish were conducted of parents of children presenting for nonurgent care on weekdays from 8 am-4 pm at the Children's Hospital of Wisconsin ED over a 4-week period. Parents were asked 20 questions from a semi-structured guide. Interview transcripts were analyzed using grounded theory.

Results – For the 31 families (37 parents) interviewed, the mean parental age was 29 years, and the mean child age was 3 years. English was the primary language for 30 parents and Spanish for 7. All patients were insured (68% publicly insured), and only one child had no primary care physician (PCP). Reasons cited by caregivers for choosing the ED over their child's PCP were: healthcare provider referral (“If my doctor recommended it, that was the only reason I went”), long appointment wait (“He wasn't able to get him in today or tomorrow, he has so many patients”), efficiency (“You can't beat it for speed”), ED resources (“They can perform a test right there”), convenience, quality of care (“I feel that the [ED] doctors are more skilled.”), dissatisfaction with the PCP (“They have bad attitudes there”), communication problems (accents and unhelpful staff at PCP), and ED expertise with children. Some parents said they would like education on the urgency of pediatric problems. When asked if her child's PCP provided such teaching, one mother replied, “It would be helpful, but no.”

Conclusions – Parents bring their children to the ED for nonurgent care because of PCP referral, efficiency, dissatisfaction with PCPs, 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.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• List reasons why parents use the emergency department (ED) for pediatric nonurgent care.
• Describe the most useful measures available to reduce pediatric nonurgent ED use.

Keywords: Underserved Populations, Emergency Department/Room

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation