Understanding Low-Acuity Visits to the Pediatric Emergency Department.
Understanding Low-Acuity Visits to the Pediatric Emergency Department.
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DOI：
10.1371/journal.pone.0128927
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Barrowman N
中科院分区：
文献类型：
--
作者：
Farion KJ;Wright M;Zemek R;Neto G;Karwowska A;Tse S;Reid S;Jabbour M;Poirier S;Moreau KA;Barrowman N
加拿大儿科急诊就诊人数正在增加，当地低敏度就诊人数的增加不成比例（2008-09年占33%，2011-12年占41%）。我们试图理解：1）呈现模式和资源影响; 2）父母的看法和动机;以及3）在呈现低敏度问题之前考虑的替代医疗保健选择。我们在两个省的三级儿科急诊科进行了一项前瞻性队列研究，以探讨有和没有初级保健提供者的患者之间的差异。在为期4周、为期2周、为期1年的研究期间，低敏度访视的父母接受了匿名调查。介绍时间，干预措施，诊断和处置被捕获的数据收集表链接到调查的研究编号。家长完成了2，443项调查（回复率为74.1%），调查数据收集表对可用于2，146次访问。总体而言，89.7%的受访者有初级保健提供者; 68%是家庭医生。令人惊讶的是，40%的就诊发生在工作日办公时间，27.3%发生在症状出现后4小时内;这些早期就诊者中有67.5%是因为受伤。很少有父母从他们的初级保健提供者（25%），健康信息热线（20.7%）或紧急护理诊所（18.5%）寻求护理; 36%的人报告说，他们认为他们的孩子的问题需要急诊科。45%的人只需要病史、体检和安慰;只有11%的人需要在办公室环境中无法获得的干预。没有初级保健提供者的患者更有可能在工作日的办公时间出现（p = 0.003），症状持续时间更长（p<0.001），并且不知道其他选择（p = 0.001）。许多家长寻求儿科急诊科照顾低敏度的问题，尽管他们的孩子有一个初级保健提供者。确保及时获得这些提供者可能有助于减少儿科急诊科的过度使用。教育举措应告知家长低视力问题以及可以/应该在哪里获得适当的护理。
Canadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents’ perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems. We conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number. Parents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child’s problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (p = 0.003), have longer symptom duration (p<0.001), and not know of other options (p = 0.001). Many parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.
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