Describing non-urgent pediatric Emergency Department utilization
Creators: name: Weiss, Jesse Michael
Publisher: name: University of Iowa
Year: 2027

description: Background: In the United States, as many as 50% of all children seen in the Emergency Department (ED) present with non-urgent conditions. There can be significant consequences when children are seen in the ED for conditions better suited for less acute settings, such as a primary care clinic. These consequences include increased costs for both families and the healthcare system, reductions in quality of care for patients in the ED, and potentially long-term health issues for the children obtaining non-urgent ED care. Researchers have discovered multiple contributors to non-urgent pediatric ED use. Of these contributors, parents perceiving their child’s condition to be urgent, is one of the most commonly cited, However, no researchers have identified the specific conditions in which parents perceive to be urgent. Filling this gap would provide a foundation for future research, as well as targeted interventions to help parents determine if, when, and where to obtain care for their children based on the child’s condition.
description: Objectives: The purpose of this dissertation is to characterize the conditions that constitute non-urgent ED visits and parents’ perceptions of the severity of these conditions.
description: Methods: This dissertation consists of two cross-sectional studies. The first of these studies involved the use of Electronic Health Record (EHR) data from a large, midwestern academic medical center to describe non-urgent pediatric ED utilization over a six-month span. The second study is a cross-sectional descriptive vignette study, that described parents’ perceptions of common pediatric illnesses and injuries.
description: Results: Through the first study we identified the most common non-urgent conditions that children present to the ED with. These conditions include fever, extremity pain, fall, extremity injury, and cough. It was also determined that fever, fall, and cough have variation in the triage scores assigned, meaning that some children receive non-urgent triage scores for these conditions and other children receive urgent triage scores for the same conditions. ED visits for non-urgent conditions also occurred at a higher rate on the weekend compared to ED visits for urgent conditions. In the second study we determined that parents perceived shortness of breath and suicidal ideation to be the most severe pediatric illnesses, while cough and stomachache were perceived to be the least severe. Overall, parents’ perceptions of severity were associated with age, with parents’ assigned severity scores increasing as the child’s age decreased for most conditions. Parents’ decisions of where to seek care for the child portrayed in the vignettes were consistent with their perceptions of severity. Specifically, parents were most likely to choose the ED for children with shortness of breath or suicidal ideation, and most likely to choose a primary care provider for a child with a cough or stomachache.
description: Conclusion: Non-urgent pediatric ED use is a highly complex issue, but one with significant consequences. Parents perceiving their child’s non-urgent condition as urgent is just one of many factors that contribute to non-urgent pediatric ED use. This dissertation expands the current body of knowledge regarding the relationship between parents’ perceptions of severity and non-urgent pediatric ED use and provides a foundation for future research and interventions. The successful development and implementation of interventions that help parents determine if, when, and where to obtain care for their children could reduce non-urgent ED pediatric ED visits and the consequences associated with them.