Understanding Low-Acuity Visits to the Pediatric Emergency Department

<div><p>Background</p><p>Canadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents’ perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems.</p><p>Methods</p><p>We conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number.</p><p>Results</p><p>Parents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child’s problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (<i>p</i> = 0.003), have longer symptom duration (<i>p</i><0.001), and not know of other options (<i>p</i> = 0.001).</p><p>Conclusions</p><p>Many parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.</p></div

Chief complaint, as reported by the parent.

<p>PCP-, Patient does not have a primary care provider (n = 210). PCP+, Patient does have a primary care provider (n = 1,854).</p

Motivations and perceptions about coming to the emergency department.

<p>PCP-, Patient does not have a primary care provider. PCP+, Patient does have a primary care provider p values represent significant differences between subgroups by Pearson’s chi-square test. * p = 0.001. ** p<0.001. *** p = 0.005.</p

Duration of symptoms prior to presentation*.

<p>PCP-, Patient does not have a primary care provider (n = 250). PCP+, Patient does have a primary care provider (n = 2,134). * p<0.001.</p

Characteristics of study patients compared to all low-acuity patients and all emergency department patients during the study period.

<p>DCF Data Collection Form</p><p>PED Pediatric Emergency Department</p><p>hrs hours</p><p>MD Medical Doctor</p><p>Characteristics of study patients compared to all low-acuity patients and all emergency department patients during the study period.</p

Time of Presentation to the Emergency Department.

<p>PCP-Patient does not have a primary care provider (n = 223). PCP+, Patient does have a primary care provider (n = 1,890). D, Days (08:00–17:00). E, Evenings (17:00–24:00). N, Nights (24:00–08:00). * <i>p</i> = 0.003.</p

Examples of common Low-Acuity (PaedCTAS level 4 and 5) Presentations.

<p>PaedCTAS Paediatric Canadian Triage and Acuity Scale</p><p>Examples of common Low-Acuity (PaedCTAS level 4 and 5) Presentations.</p