Barwise-Munro Rebecca, Morgan Heather, Turner Steve
Child Health, University of Aberdeen, Aberdeen AB24 3FX, UK.
Health Services Research Unit, University of Aberdeen, Aberdeen AB24 3FX, UK.
Healthcare (Basel). 2018 Sep 17;6(3):117. doi: 10.3390/healthcare6030117.
The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission.
Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians).
Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described "erring on the side of caution" when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, "erring on the side of caution" was also identified as was managing "parental anxiety" and acting on "gut instinct". Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service.
The study of parent and referring clinician decision-making prior to a hospital admission can identify "teachable moments" where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as "parental anxiety".
儿科急性医疗紧急入院人数正在上升。我们对家长和临床医生进行了定性访谈，以更好地了解除儿童健康状况外，还有哪些因素可能影响导致紧急入院的决策过程。
我们对家长、在全科医疗、非工作时间服务或急诊科工作的临床医生（转诊临床医生）以及从事儿科急性医疗工作的医生（接收临床医生）进行了半结构化访谈。
我们访谈了10名家长、7名转诊临床医生和10名接收临床医生。家长们表示在寻求医疗建议时“宁可谨慎过头”，有一位提到了焦虑情绪。在转诊临床医生中发现的主题里，“宁可谨慎过头”以及应对“家长焦虑”和凭“直觉”行事也被提及。在接收临床医生中，主题包括应对家长焦虑以及提高家长对医疗服务的期望。
对入院前家长和转诊临床医生决策过程的研究能够确定“可教育时机”，通过这些时机可采取干预措施，以减缓甚至遏制英国及其他国家短期急性医疗入院人数的上升。干预措施可以向家长或转诊临床医生保证无需转诊至医院，并帮助临床医生理解他们所认为的“家长焦虑”。
