title: Advice seeking and appropriate use of a pediatric emergency department.
abstract: OBJECTIVE
  To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.
  
  
  METHODS
  Cross-sectional questionnaire survey.
  
  
  METHODS
  The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.
  
  
  METHODS
  Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.
  
  
  METHODS
  None.
  
  
  RESULTS
  Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P < .05). In multivariate analysis, having a regular physician and being one of two children also contributed to appropriateness.
  
  
  CONCLUSIONS
  Appropriate use of the PED was positively influenced by seeking prior advice from both a physician and family member, having a regular physician, and having prior child care experience.
authors.affiliation: Department of Developmental and Behavioral Pediatrics, Children's Hospital, Boston, MA.
authors.forename: T F
authors.initials: TF
authors.lastname: Oberlander
authors.forename: I B
authors.initials: IB
authors.lastname: Pless
authors.forename: G E
authors.initials: GE
authors.lastname: Dougherty
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D001722:Birth Order; D002648:Child; D002675:Child, Preschool; D003376:Counseling / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000193:education / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011792:Quebec; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires