ORIGINAL CONTRIBUTION
Nonemergency Visits To a Pediatric Emergency Department Terry L. Hilker, BS, MS Columbus, Ohio
We examined six factors that may help to explain why parents take their children to hospital emergency departments: arrival time; travel time; who decided the patient should go; did the patient have a physician; did the parent attempt physician contact, and where the parent would have preferred to have gone for treatment. Results indicate that 47% of the nenemergency visits occurred dudng the time when physicians maintain offme hours. Most visits were made by patients living less than 15 minutes away from the hospital Physicians decided that the patient should go to the emergency department 18=/o of the time. Patients with a private physician accounted for 80% of the visits, Most parents did nat try to contact a physician prior to the visit. Indeed, 46% of the parents preferred to take their children to the emergency department rather than to a physician's office. Rnally, 74% of the parents who attempted some contact with a member of the health care system wore referred to theemergency department for care. Hilker TL: Nonemergency visits to a pediatric emergency department. JACEP 7"~3-8January, 1978. emergency department, pediatric nonemergency; pediatric, nonemergency visits.
INTRODUCTION Hospital emergency d e p a r t m e n t utilization is the subject of considerable att e n t i o n t h r o u g h o u t the U n i t e d States. While m a n y studies " 3 have investigated a community's emergency utilization, few TM have dealt specifically with the provision of emergency care to children. In addition, much of the literature is descriptive with few a t t e m p t s to explain the reasons for p a t i e n t behavior. The purpose of this study was to investigate why p a r e n t s use the emergency departm e n t r a t h e r t h a n a private physician for the h e a l t h care of t h e i r children. Differences in defining the p a t i e n t triage classification - - ie, emergency, urgent, and n o n u r g e n t - - can, and do, lead to a variety of results in studies of emergency d e p a r t m e n t use. Equally important, the p a t i e n t or his parents m a y define these classifications quite differently from the hospital emergency department. For the purpose of this article, the following terms are defined as
(Children's Hospital of Akron Emergency Department Policy and Procedure Man ual.): emergent: The severely ill or injured, r e q u i r i n g immediate a t t e n t i o n to combat danger to life and limb and i n whom delay of only a few hours would result in deterioration. urgent: Illness or i n j u r y r e q u i r i n g a t t e n t i o n w i t h i n a few hours, but delay poses no t h r e a t to life or limb; p a t i e n t is not in severe pain, and does not pose a n y danger to himself or others. From the Children's Hospital of Akron, Akron, Ohio; Ocean Reef Medical Center, Key Largo, Florida; and Graduate Program in Hospital and Health Service Administration, Ohio State University, Columbus, Ohio.
7:1 (Jan)1978
Address for reprints: Terry L. Hilker, Ocean Reef Medical Center, 30 Ocean Reef Drive, Key Largo, Florida 33037.
JACEP
3/9
nonurgent: A p a t i e n t to whom a delay of 24 hours would make no appreciable difference in the clinical condition. scheduled: P r i v a t e o u t p a t i e n t s , follow-up of i n j u r i e s directed back to the emergency department. The following eight hypotheses were developed to e v a l u a t e i m p o r t a n t characteristics of p a r e n t s who take their children to the emergency dep a r t m e n t for n o n e m e r g e n c y care, ie, not classified as emergent. 1) P a r e n t s take their children to t h e emergency d e p a r t m e n t for nonemergency care d u r i n g those hours when a private physician is usually not available. 2) The majority of parents who take their children to the emergency d e p a r t m e n t for n o n e m e r g e n c y care travel less t h a n 15 minutes. 3) The parent, in most cases, is the person responsible for deciding t h a t a child r e q u i r i n g nonemergency care should be taken. 4) The majority of p a r e n t s who take t h e i r children for nonemergency • care do not have a private physician in the area who could be contacted for health problems. 5) Most p a r e n t s who take their c h i l d r e n for n o n e m e r g e n c y care do not even a t t e m p t to contact a private physician. 6) Most p a r e n t s who do t r y to contact a physician prior to t a k i n g their c h i l d r e n are told by either the physician or his office personnel to go to the emergency department. 7) Most parents who do not try to contact a physician assume t h a t he would be u n a v a i l a b l e . 8) W h e n compared to the alternative of a n office visit, most parents prefer to use the emergency department. METHODS
This study was conducted at The Children's Hospital of Akron in Akron, Ohio d u r i n g t h e m o n t h s of J a n u a r y a n d F e b r u a r y of 1977, and involved 652 parents. The i n s t i t u t i o n i s a f u l l y a c c r e d i t e d , a c u t e care t e a c h i n g hospital of 245 beds serving a n area of 11 e a s t e r n Ohio counties. It is a r e g i o n a l p e d i a t r i c m e d i c a l center providing v i r t u a l l y all of the p e d i a t r i c beds s e r v i n g 5 0 0 , 0 0 0 people. Of the five hospitals in Akron, o n l y T h e C h i l d r e n ' s H o s p i t a l of Akron provides e m e r g e n c y care for children. The emergency d e p a r t m e n t is h o u s e d i n a f u l l y m o d e r n , oneyear-old s t r u c t u r e , and accept s all lO/4
Table 1 ARRIVAL TIME Time
Week 1
Week 2
Total
5 pm
102
205
307
47
5 p m - 11 p m
68
191
259
40
8 am -
11 p m -
8 am
TOTAL
Percentage
31
55
86
13
201
451
652
100
Factorial Analysis: F = 0.55; p>0.05
Table 2 TRAVEL TIME Distance from the Hospital
No.
Percent
U n d e r 15 minutes
399
O v e r 15 minutes
253
39
652
100
TOTAL
61
Factorial Analysis: F = 6,91; p
Nonemergency Visits To a Pediatric Emergency Department Terry L. Hilker, BS, MS Columbus, Ohio
We examined six factors that may help to explain why parents take their children to hospital emergency departments: arrival time; travel time; who decided the patient should go; did the patient have a physician; did the parent attempt physician contact, and where the parent would have preferred to have gone for treatment. Results indicate that 47% of the nenemergency visits occurred dudng the time when physicians maintain offme hours. Most visits were made by patients living less than 15 minutes away from the hospital Physicians decided that the patient should go to the emergency department 18=/o of the time. Patients with a private physician accounted for 80% of the visits, Most parents did nat try to contact a physician prior to the visit. Indeed, 46% of the parents preferred to take their children to the emergency department rather than to a physician's office. Rnally, 74% of the parents who attempted some contact with a member of the health care system wore referred to theemergency department for care. Hilker TL: Nonemergency visits to a pediatric emergency department. JACEP 7"~3-8January, 1978. emergency department, pediatric nonemergency; pediatric, nonemergency visits.
INTRODUCTION Hospital emergency d e p a r t m e n t utilization is the subject of considerable att e n t i o n t h r o u g h o u t the U n i t e d States. While m a n y studies " 3 have investigated a community's emergency utilization, few TM have dealt specifically with the provision of emergency care to children. In addition, much of the literature is descriptive with few a t t e m p t s to explain the reasons for p a t i e n t behavior. The purpose of this study was to investigate why p a r e n t s use the emergency departm e n t r a t h e r t h a n a private physician for the h e a l t h care of t h e i r children. Differences in defining the p a t i e n t triage classification - - ie, emergency, urgent, and n o n u r g e n t - - can, and do, lead to a variety of results in studies of emergency d e p a r t m e n t use. Equally important, the p a t i e n t or his parents m a y define these classifications quite differently from the hospital emergency department. For the purpose of this article, the following terms are defined as
(Children's Hospital of Akron Emergency Department Policy and Procedure Man ual.): emergent: The severely ill or injured, r e q u i r i n g immediate a t t e n t i o n to combat danger to life and limb and i n whom delay of only a few hours would result in deterioration. urgent: Illness or i n j u r y r e q u i r i n g a t t e n t i o n w i t h i n a few hours, but delay poses no t h r e a t to life or limb; p a t i e n t is not in severe pain, and does not pose a n y danger to himself or others. From the Children's Hospital of Akron, Akron, Ohio; Ocean Reef Medical Center, Key Largo, Florida; and Graduate Program in Hospital and Health Service Administration, Ohio State University, Columbus, Ohio.
7:1 (Jan)1978
Address for reprints: Terry L. Hilker, Ocean Reef Medical Center, 30 Ocean Reef Drive, Key Largo, Florida 33037.
JACEP
3/9
nonurgent: A p a t i e n t to whom a delay of 24 hours would make no appreciable difference in the clinical condition. scheduled: P r i v a t e o u t p a t i e n t s , follow-up of i n j u r i e s directed back to the emergency department. The following eight hypotheses were developed to e v a l u a t e i m p o r t a n t characteristics of p a r e n t s who take their children to the emergency dep a r t m e n t for n o n e m e r g e n c y care, ie, not classified as emergent. 1) P a r e n t s take their children to t h e emergency d e p a r t m e n t for nonemergency care d u r i n g those hours when a private physician is usually not available. 2) The majority of parents who take their children to the emergency d e p a r t m e n t for n o n e m e r g e n c y care travel less t h a n 15 minutes. 3) The parent, in most cases, is the person responsible for deciding t h a t a child r e q u i r i n g nonemergency care should be taken. 4) The majority of p a r e n t s who take t h e i r children for nonemergency • care do not have a private physician in the area who could be contacted for health problems. 5) Most p a r e n t s who take their c h i l d r e n for n o n e m e r g e n c y care do not even a t t e m p t to contact a private physician. 6) Most p a r e n t s who do t r y to contact a physician prior to t a k i n g their c h i l d r e n are told by either the physician or his office personnel to go to the emergency department. 7) Most parents who do not try to contact a physician assume t h a t he would be u n a v a i l a b l e . 8) W h e n compared to the alternative of a n office visit, most parents prefer to use the emergency department. METHODS
This study was conducted at The Children's Hospital of Akron in Akron, Ohio d u r i n g t h e m o n t h s of J a n u a r y a n d F e b r u a r y of 1977, and involved 652 parents. The i n s t i t u t i o n i s a f u l l y a c c r e d i t e d , a c u t e care t e a c h i n g hospital of 245 beds serving a n area of 11 e a s t e r n Ohio counties. It is a r e g i o n a l p e d i a t r i c m e d i c a l center providing v i r t u a l l y all of the p e d i a t r i c beds s e r v i n g 5 0 0 , 0 0 0 people. Of the five hospitals in Akron, o n l y T h e C h i l d r e n ' s H o s p i t a l of Akron provides e m e r g e n c y care for children. The emergency d e p a r t m e n t is h o u s e d i n a f u l l y m o d e r n , oneyear-old s t r u c t u r e , and accept s all lO/4
Table 1 ARRIVAL TIME Time
Week 1
Week 2
Total
5 pm
102
205
307
47
5 p m - 11 p m
68
191
259
40
8 am -
11 p m -
8 am
TOTAL
Percentage
31
55
86
13
201
451
652
100
Factorial Analysis: F = 0.55; p>0.05
Table 2 TRAVEL TIME Distance from the Hospital
No.
Percent
U n d e r 15 minutes
399
O v e r 15 minutes
253
39
652
100
TOTAL
61
Factorial Analysis: F = 6,91; p
