Augustine Erin M, Kreling Barbara A, Chamberlain James M
From the *Department of Emergency Medicine, Children's National Health System, Washington, DC. †Not affiliated to any institution.
Pediatr Emerg Care. 2016 Sep;32(9):594-8. doi: 10.1097/PEC.0000000000000781.
Approximately 5% of pediatric patients return to the emergency department (ED) within 72 hours of initial evaluation. The goal of this study was to identify reasons for return visits from the caretaker perspective.
Two parent focus groups were conducted in November 2012. Parents were excluded from participation if the return visit was unrelated to the initial visit or the child was asked to return (e.g., wound check). The focus groups were audiotaped, transcribed, and analyzed using a thematic content analysis approach.
A total of 13 parents participated. Children were 10 months to 11 years of age (median, 3.1 years). Primary symptoms and diagnoses were related to respiratory (n = 6); gastrointestinal (n = 2); dermatologic (n = 2); musculoskeletal (n = 2); and ear, nose, throat and mouth diseases (n = 1). Return visits occurred 12 to 50 hours (median, 24 hours) after the initial visit. Reasons for return visits were divided into 4 domains: (1) the caretaker's response to the initial visit (e.g., dissatisfaction with medical staff, medical care, or information provided), (2) the child's illness (e.g., continued, worsening, or concerning symptoms), (3) the nature of the ED itself (e.g., subspecialist availability, convenient hours), and (4) follow-up care (e.g., lack of appointments with primary physicians or subspecialists).
Several of the reasons parents identify for return visits are within the locus of control of the ED, and several could be addressed by improving regional health care coordination. Surveys based on these themes will quantitate the reasons for return visits and prioritize future strategies to address the perceived need for return visits.
约5%的儿科患者在首次评估后的72小时内返回急诊科（ED）。本研究的目的是从看护者的角度确定复诊原因。
2012年11月进行了两个家长焦点小组访谈。如果复诊与首次就诊无关或孩子被要求复诊（如伤口检查），则家长被排除在参与范围之外。焦点小组访谈进行了录音、转录，并采用主题内容分析方法进行分析。
共有13名家长参与。孩子年龄在10个月至11岁之间（中位数为3.1岁）。主要症状和诊断与呼吸系统疾病（n = 6）、胃肠道疾病（n = 2）、皮肤病（n = 2）、肌肉骨骼疾病（n = 2）以及耳鼻喉口腔疾病（n = 1）有关。复诊发生在首次就诊后的12至50小时（中位数为24小时）。复诊原因分为4个领域：（1）看护者对首次就诊的反应（如对医护人员、医疗护理或提供的信息不满意），（2）孩子的病情（如症状持续、加重或令人担忧），（3）急诊科本身的性质（如专科医生可用性、方便的就诊时间），以及（4）后续护理（如缺乏与初级医生或专科医生的预约）。
家长指出的复诊原因中有几个在急诊科的可控范围内，还有几个可以通过改善区域医疗协调来解决。基于这些主题的调查将量化复诊原因，并为满足复诊需求的未来策略确定优先顺序。
