From the Dayton Children's Hospital.
Wright State University BSOM, Dayton, OH.
Pediatr Emerg Care. 2024 Sep 1;40(9):668-673. doi: 10.1097/PEC.0000000000003195. Epub 2024 Mar 27.
Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions.
Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels.
Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED.
This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.
合理利用急诊部门（ED）是人群健康的一个重要标志。由于非紧急就诊导致的 ED 过度拥挤，给医护人员带来了更大的压力，增加了成本，并延长了更紧急病例的等待时间。本研究旨在更好地了解大流行后护理人员带孩子非紧急就诊的原因，并制定有效的干预措施，以改善护理人员对非紧急情况非 ED 护理的选择。
对城市儿科医院进行了急诊严重程度指数（ESI）3 至 5 级就诊的调查。共完成了 602 份调查，其中 8 份被排除在分析之外。收集了调查响应和匿名人口统计信息。根据受访者年龄类别、与孩子的关系、孩子的种族、保险类型和 ESI 水平对调查进行分组，比较调查响应。
非紧急 ED 就诊的主要原因是感知到的紧急情况（74.2%，n=441）、ED 优于其他地点（23.9%，n=142）和第三方转介至 ED（17.7%，n=105）。在那些将感知到的紧急情况作为原因之一的人中，80.5%（n=355）希望尽快减轻孩子的疼痛/不适，但只有 13.6%（n=60）表示孩子病得太重，不能在其他地方就诊。在将孩子带到 ED 的主要和次要原因的比例方面，出现了人口统计学差异。
本研究强调了 3 个关键发现。立即寻求护理是护理人员决定低危就诊的关键因素。在推荐护理地点方面存在潜在的社会经济和种族偏见，需要在本地区进一步探讨。针对寻求低危护理关键原因的跨社区干预措施最有可能影响 ED 对低危疾病的使用。
