Appropriateness of children's nonurgent visits to selected Michigan emergency departments

Rachel Stanley, Jessica Zimmerman, Christopher Hashikawa, Sarah J Clark
Pediatric Emergency Care 2007, 23 (8): 532-6

OBJECTIVES: To explore parental rationale and the appropriateness of children's visits to emergency departments (EDs) for nonurgent complaints.

METHODS: At 13 Michigan EDs, interviews were conducted with parents of children aged 6 months to 18 years who were triaged by ED personnel as lowest acuity. Interviews explored chief complaint, reason for ED visit, insurance status, attempts to call for advice before coming to the ED, and usual primary care source. Investigators rated ED visit appropriateness as high, medium, or low based on characteristics of the complaint and parent care-seeking behaviors.

RESULTS: Of 422 completed interviews, 51% involved parents of Medicaid enrollees, and 43% involved parents of privately insured enrollees. One third of children presented with injuries. Overall, 50% of visits were rated as high appropriateness. When injuries were excluded, 37% of visits were rated as high appropriateness. Thirty-eight percent of parents called for advice before coming to the ED; of those, 60% were told to go to the ED. The most common parent-reported reason for going to the ED was reassurance (41%), followed by thinking the situation was an emergency (33%). Medicaid patients who could name a primary care physician, rather than a clinic only, were more likely to have ED visits rated as high appropriateness (54% vs 38%, P < 0.05).

CONCLUSIONS: Half of all nonurgent ED visits were rated as high appropriateness. Considering parental information sources, it would be incorrect to label all nonurgent ED visits as inappropriate. Questions remain as to whether primary care outpatient sites are an appropriate source of care for minor injuries.

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