Franklin Courtney, Taylor-Robinson David, Carrol Enitan D, Moran Paul, Carter Bernie
Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
Public Health and Policy, University of Liverpool, Liverpool, UK.
BMJ Paediatr Open. 2024 Dec 24;8(1):e003039. doi: 10.1136/bmjpo-2024-003039.
Paediatric emergency department (ED) attendances and admissions in England are increasing. Fever is a common presenting problem for these attendances. Anxiety and misperceptions surrounding appropriate management of fever persist among parents. Little evidence exists on the pathways to ED for fever, and doctors' perceptions of why parents present their child to the ED.
To understand perceptions of parents and doctors of the reasons for ED presentation for children (0-18 years) with fever in England.
This forms the first part of a qualitative study, using reflective thematic analysis.
15 parents (12 mothers and 3 fathers) who had taken their febrile child to hospital (2015-2023), and 5 ED doctors (4 consultants and 1 resident doctor) who had experienced treating a febrile child in an ED in England.
Semistructured remote (Zoom) interviews were conducted (2022-2023).
Reflexive thematic analysis facilitated investigation into current parental concerns regarding fever and decision-making leading to ED attendance. The overarching theme 'factors influencing unscheduled care' comprised four key themes that reflected the complex interplay between factors influencing parental decision-making to seek emergency care, at the individual and wider structural level. These were parental proficiency and experience; social networks and access to services; fever phobia, uncertainty and anxiety; and reassurance. Doctors also acknowledged the importance of these factors, such as reassurance and showing compassion and further indicated a persistent educational gap surrounding fever between doctors and parents.
We widen the evidence base of why parents attend ED for paediatric fever and their perceptions of other health services. Parents face challenges when seeking care and perceived ED as a last resort. Interventions to support parental decision-making and management of fever could help to alleviate these challenges, as well as potentially reducing the demand for emergency care.
英格兰儿科急诊科的就诊人数和住院人数正在增加。发热是这些就诊病例中常见的症状。家长们对发热的适当处理仍存在焦虑和误解。关于因发热前往急诊科的途径以及医生对家长送孩子去急诊科原因的看法，几乎没有相关证据。
了解英格兰0至18岁发热儿童家长和医生对前往急诊科就诊原因的看法。
这是一项定性研究的第一部分，采用反思性主题分析。
15名在2015年至2023年间带发热孩子去医院的家长（12名母亲和3名父亲），以及5名在英格兰急诊科有治疗发热儿童经验的急诊科医生（4名顾问医生和1名住院医生）。
在2022年至2023年期间进行了半结构化远程（Zoom）访谈。
反思性主题分析有助于调查当前家长对发热的担忧以及导致前往急诊科就诊的决策过程。总体主题“影响非预约护理的因素”包括四个关键主题，反映了在个体和更广泛的结构层面上影响家长寻求紧急护理决策的因素之间的复杂相互作用。这些主题是家长的知识水平和经验；社交网络和服务可及性；发热恐惧症、不确定性和焦虑；以及安心感。医生也认识到这些因素的重要性，比如安心感和表现出同情心，并进一步指出医生和家长在发热问题上存在持续的教育差距。
我们拓宽了关于家长因儿科发热前往急诊科的原因及其对其他医疗服务看法的证据基础。家长在寻求护理时面临挑战，并将急诊科视为最后的求助途径。支持家长进行发热决策和管理的干预措施有助于缓解这些挑战，并有可能减少对紧急护理的需求。
