An unanticipated increase in patient visits to a pediatric emergency department.

This study was conducted to explain a more than threefold increase in anticipated patient visits associated with the opening of a separate pediatric emergency department (PED) 2 miles from the nearest general emergency department. Population demographics and data pertaining to visits to other emergency departments were obtained. Parents visiting the new PED were surveyed using a standardized questionnaire. Over the study period (1984-1989), the city population increased by 7%; school population increased by 17%, with no increase in birth rate. Total patient visits to the other city hospitals increased by less than 10%, while the number of visits to the PED increased 250% over anticipated visits. Of children visiting the PED, 48% were less than 5 years old, 30% had lived at their current address less than 2 years, and 80% came from the geographic area close to the PED. Parental decision to bring the child to the PED was as follows: a service perceived to be "for kids" (47%), previous visit (42%), closest facility (33%), better service (20%), referred (12%), and pediatrician availability (10%). The PED is staffed by licensed pediatricians, whereas the general emergency departments are staffed by emergency physicians. We conclude that the increase in visits cannot be accounted for by increases in regional population base only. Anticipated patient volume to a new health care facility should not be based on population demographics only, but on other factors such as user perception of facility. Patient or parent preference should also be considered.