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Factors Associated With Emergency Department Utilization for Nonurgent Pediatric Problems
Kevin Phelps, DO;
Christine Taylor, PhD;
Sanford Kimmel, MD;
Rollin Nagel, PhD;
William Klein, MD;
Sandra Puczynski, PhD
Arch Fam Med. 2000;9:1086-1092.
Objective To identify specific caretaker and utilization characteristics predictive of the use of the emergency departments (EDs) for nonurgent reasons. Each year more than 20 million children in the United States seek medical care in EDs. Between one third and one half of these visits are for nonurgent reasons.
Design A descriptive study conducted during a 6-month period.
Setting Two urban hospital EDs.
Measure A questionnaire was designed to elicit information about specific caretaker characteristics and their reasons for using the ED for their child's nonurgent medical care.
Subjects Two hundred caretakers and children brought to the ED for nonacute medical care. Caretakers in this study included mothers (82%) with a mean age of 30 years, single caretakers (70%), and unemployed caretakers (60%). The average age of the children was 6.2 years.
Results Most caretakers (92%) reported having a continuity physician for their children. Caretakers who reported being taken to the ED when they were children (P<.002) and those with Medicaid insurance (P<.001) were more likely to view the ED as the usual site of care. Being a single parent was a predictor for nonurgent visits (P<.05).
Conclusions Predicting which caretakers are at risk for using the ED for nonurgent care when their children are sick provides the primary care physician a means of identifying specific patients who may benefit from interventions designed to promote a more cost-effective approach to using medical resources.
From the Department of Family Medicine, Medical College of Ohio, Toledo. Dr Klein is currently a fellow in sports medicine at Providence Hospital, Southfield, Mich.
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