Use and Misuse of Emergency Room for Children: Features of Walk-In Consultations and Parental Motivations in a Hospital in Southern Italy

Abstract

Objective: Inappropriate use of the emergency department (ED) represents a major worldwide issue both in pediatric and adult age. Herein, we aim to describe features of pediatric visits to the ED of Salerno University Hospital and to evaluate parental reasons behind the decision to walk in.Materials and Methods: We performed a retrospective observational study evaluating ED encounters for children from January 2014 to December 2019. The appropriateness of visits was measured with a national tool assessing every ED encounter, namely, “the Mattoni method,” which consists of the combination of the triage code assigned, the diagnostic resources adopted, and the consultation outcomes. Moreover, 64 questionnaires were collected from a sample of parents in the waiting rooms in January 2020.Results: A total number of 42,507 visits were recorded during the study period (19,126 females; mean age ± SD: 4.3 ± 3.8 years), the majority of whom were inappropriate (75.8% over the considered period; 73.6% in 2014; 74.6% in 2015; 76.3% in 2016; 76.7% in 2017; 77.9% in 2018; 75.5% in 2019). Most of the inappropriate consultations arrived at the ED by their own vehicle (94.4%), following an independent decision of the parents (97.2%), especially in the evening and at night on Saturdays/Sundays/holidays (69.7%). A multivariate analysis revealed the following: patients of younger age (OR: 1.11, 95% C.I. 1.06–1.16; p < 0.0019), night visits (OR 1.39; 95% C.I.: 1.32–1.47; p < 0.001), patients living in the municipality of Salerno (OR 1.28; 95% C.I.: 1.22–1.34; p < 0.001), weekend day visits (OR 1.48; 95% C.I.: 1.41–1.56; p < 0.001), and independent parental decision without previous contact with primary care pediatrician (OR 3.01; 95% C.I.: 2.64–3.44; p < 0.001) were all significant independent predictors of inappropriate consultation. The most frequent trigger of ED encounters was fever (51.4%). Hospital admission made up 17.6% of all consultations. The questionnaire showed that most parents were aware of the lack of urgency (20.3%) or minor urgency (53.1%) of the visit. The reasons for walking in were the impossibility to receive a home consultation (70%), the difficulty of contacting their family pediatrician during weekends and holidays (54.4%), as well as the search for a quick, effective, diagnosis and therapy (48.4%).Conclusions: The study suggests a highly inappropriate use of ED for children in our region. This issue deserves considerable attention by health care system leaders in order to optimally integrate hospitals and primary care.

The Ratio and Predictor Factors of Inappropriate and Unnecessary Use of Emergency Department Services

“…Also based on regression analysis of demographic variables such as age, education, place of residence, marital status, time and day of admission, if the day of admission was off or not and previous admission record in the ED, although no numerical difference was found in the use of ED inappropriate services, it was not statistically significant. However, some studies have shown that age, education, time, and day of admission and if the day of admission was off or not [10,28,[35][36][37] have affected the rate of ED inappropriate admission. However, the results of some studies in the case of the insignificance of the effect of some of the mentioned variables on the rate of ED inappropriate admissions were consistent with the results of the present study.…”

Smartphone App PACOM to Provide Advice Regarding Self-Triage for the Acute Primary Care Needs of Children

“…17 In another study conducted in Italy, 73% of caregivers who visited the ED were aware of the lack of urgency of their child's condition. 18 The "Quick Look" algorithm does not improve the detection of urgent care needs for children by parents, perhaps because parents did not interpret the questions in the same way as the doctor. Involving parents in the formulation and testing of this specific algorithm would improve its diagnostic performance.…”

“…In a study conducted in Lithuania, approximately 40% of caregivers perceived the need for urgent care for their children, whereas ED professionals estimated that only 20% of these children needed urgent care 17 . In another study conducted in Italy, 73% of caregivers who visited the ED were aware of the lack of urgency of their child's condition 18 . The “Quick Look” algorithm does not improve the detection of urgent care needs for children by parents, perhaps because parents did not interpret the questions in the same way as the doctor.…”

The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services during the first pandemic wave: A system-wide study of Tuscany Region, Italy

“…This dramatic decline of EMS utilization in this age group is probably due to a combination of factors such as the reduction of trauma and injuries related to closure of schools, leisure and sport activities, and the reduction of recrudescence of diseases related to air pollution and of other infectious diseases [38][39][40][41]. Furthermore, it should be pointed out that inappropriate utilization of EMS is commonly reported for paediatric patients [38,42], however delayed presentation for acute illnesses-probably linked to the reduced access to primary care-were reported during the first wave of the pandemic [38,40].…”