Community-based research to reduce non-urgent use of a pediatric emergency department

This presentation describes the processes used to: 1.) better understand the non-urgent use of emergency department (ED) services at an urban pediatric hospital and academic medical center and 2) identify appropriate interventions to address this issue. Non-urgent or avoidable visits to the ED continue to emerge as important to understand since they contribute to overcrowding, increased costs and health disparities among children in poor and underserved communities. Indeed, there is growing evidence that parents and other caregivers frequently turn to the ED for non-urgent or preventable pediatric care that would ideally be delivered in a community primary care setting. The result is overcrowding in many EDs, poorer outcomes, increased disparities, and higher health care costs.

In our own pediatric institution, over 65,000 patients presented to the ED in the past year; of those, 48% were categorized as non-urgent. The majority of these patients (62%) lived within a five-mile radius of the hospital. The surrounding community is ethnically diverse, comprised of 62% Latino, 17% Caucasian, 5% African American, and 16% Asian/Pacific Islander. The community is also home to a large immigrant population and is a common “entry point” for recent immigrants from such places as Mexico, Central America, Armenia, Thailand, Philippines, and Russia. This poses linguistic and cultural challenges to ensuring access to and use of needed healthcare services for children and families. A community-based research approach was developed to engage community partners vested in this issue, (e.g., clinic personnel, child health advocates, health plan representatives, parents, ED clinical staff, health services researchers). A community advisory board (CAB) was developed with these partners as an opportunity for members to share experiences and knowledge around non-urgent/urgent use of emergency pediatric services. The CAB was then charged with: 1) examining hospital data related to non-urgent ED usage; 2) planning for prospective data collection (e.g., parent/provider survey, key informant interviews, parent focus groups); 3) reviewing existing interventions; and 4) suggesting novel/potential interventions.

Among the reasons identified for using ED services for non-urgent care were convenience, cultural norms, trust, limited health literacy and limited access to other services. A range of interventions developed to address these issues were reviewed relevant to the patient population. Recommendations for effective interventions could play a significant role in reducing disparities, while also supporting a more financially sustainable structure of necessary pediatric care throughout Los Angeles County. Next steps include the design and implementation of pilot tests for selected interventions.