Pediatrician offices need to do a better job of accommodating and educating patients families in order to reduce the number of children being brought to hospital emergency departments with nonurgent needs, according to a report in the latest edition of the journal Academic Pediatrics released today.
Researchers conducted extensive interviews with 31 people who brought children with nonurgent care needs during normal physician office hours to the emergency department of 236-bed Childrens Hospital of Wisconsin, Milwaukee, over a four-week period in June and July 2005. The primary reasons for visiting the ED were fever, 26%, cold symptoms such as throat or ear pain, 21%; rash, 15%; minor trauma, 12%; vomiting or diarrhea, 9%; and fussiness, 6%. The authors cited other reports stating that children account for 28 million, or 25%, of hospital ED visits, and 58% to 82% are for nonurgent conditions leading to higher risks for adverse events, longer waits for other patients and increased costs.
Although they were not ranked, the study listed several reasons for going to the emergency room including long appointment waits for their regular primary-care physician, dissatisfaction with the care given by their regular physician, communication problems (including one respondent who claimed she couldnt understand the physicians accent), referral to the ED by their physician, and perceptions that the ED was more efficient and had more expertisein part, because hospital staff appeared more likely to order tests.
The authors wrote that in order to reduce nonurgent pediatric ED visits, primary-care physicians need to improve access and healthcare experiences. They also need to educate their staffs on when ED referrals are most necessary and educate families on the importance of continuity of care, how to manage ear pain, fever and rashes, and that labs are not necessarily needed for the evaluation of fever.
I dont think were saying the pediatricians arent doing a good job, said co-author Jane Brotanek, assistant professor of pediatrics at the 422-bed University of Texas Southwestern Medical Center at Dallas, adding that it was hard to calculate the cost of using the ED for nonurgent pediatric care or if convenient care clinics in retail settings have lessened this demand.
Its critical to have good communication between the primary-care providers and parents, she said, explaining that part of this communication can include supplying parents with handouts explaining what conditions can be safely managed at home and what requires an ED visit.
Almost all (97%) the children studied had a primary-care physician, 68% were publicly insured, 18% were privately insured and 9% had coverage listed as other. According to the report, the Childrens Hospital of Wisconsin serves a combined urban/suburban population and sees about 55,000 patients annually. -- by Andis Robeznieks