It is not uncommon for families to bring multiple children to the ED for evaluation at a single visit. These children often require fewer ED resources than patients presenting individually. “Non-urgent visits can become a significant obstacle to throughput and optimal use of the ED,” says Ilene Claudius, MD. These patients tend to have lower triage acuity and low hospital admission rates when compared with the general patient population.
Assessing Urgent Care Needs
In the Western Journal of Emergency Medicine, Dr. Claudius and colleagues had a study published that examined the actual need for urgent interventions in children of families registering multiple patients at once and compared these findings with families that registered single patients. Using a retrospective chart review, the investigators considered five interventions to be critical (admission, subspecialty consultation, performance of procedures, IV fluid administration, and observation for more than 6 hours).
A sample of 83 patients from 41 families that registered multiple children was compared with 248 singleton controls. Only 4.8% of patients from families registering multiple children required critical ED interventions, compared with a 32.5% rate observed for families registering just one child. “While many children required medical care, our study showed that the vast majority of care that was required by families registering multiple children could have been rendered in a primary care setting,” says Dr. Claudius. “Families presenting with multiple children as patients mainly fell into a non-urgent category in terms of need for ED resource use.”
A Continuing Problem
The concept of patients using EDs as primary care has been well established in published research. “In many cases, parents may realize that their child’s condition is non-urgent,” Dr. Claudius says. She adds that several factors may be at play, including better convenience and availability at EDs, illness perception, difficulty reaching or getting appointments with primary care providers, and confidence in ED services.
Every effort should be made to improve the healthcare system so that families will be more likely to use primary care for non-urgent treatment, according to Dr. Claudius. “To alleviate the burden, primary care centers may need to broaden their hours of operation or use other interventions like telephone triage,” she says. “Patients also must be empowered to recognize when it’s appropriate to use the ED and when primary care use would be better. They also need to be informed of the cost ramifications of ED care for non-urgent situations. With greater patient education, we can reserve ED use for those who truly need it.”
Readings & Resources (click to view)
Lemus J, Chacko M, Claudius I. Need for intervention in families presenting to the emergency department with multiple children as patients. West J Emerg Med. 2013;14:525-528. Available at: http://escholarship.org/uc/item/5712h4pd#page-1.
Kannikeswaran N, Sethuraman U, Rao S, et al. “Family plan”-multiple- patient visits from the same family to an inner city pediatric department. Pediatr Emerg Care. 2011;27:390-393.
Huang CJ, Poirier MP, Cantwell JR, et al. Prudent layperson definition of an emergent pediatric medical condition. Clin Pediatr. 2006;45:149-155.
Davis JW, Fujimoto RY, Chan H, et al. Identifying characteristics of patients with low urgency emergency department visits in a managed care setting. Manag Care. 2010:19:38-44.