title: Nonurgent use of a pediatric emergency department: a preliminary qualitative study.
abstract: OBJECTIVE
  To understand patterns of decision making among families presenting to a pediatric emergency department (ED) for nonacute care and to understand pediatric ED staff responses.
  
  
  METHODS
  Cross-sectional qualitative study using in-depth interviews, direct observations, and nonidentifying demographic data.
  
  
  RESULTS
  Eleven percent of visits made during the study period were identified as nonacute. All were made by families from low-income areas. Three main themes emerged: (1) most families had been referred by their primary care providers; (2) the complexity of living in low-income areas makes the ED a choice of convenience for these stressed families; and (3) mistrust of primary health services was not identified by our respondents as a motivator for ED utilization, in contrast with other published data. Two themes emerged from ED staff: (1) actual nonurgent visit rates were lower than staff estimates; and (2) these visits produced frustration among staff members, although their degrees of insight and understanding of factors motivating these visits were variable.
  
  
  CONCLUSIONS
  In this setting, nonacute visits occurred with lower than perceived frequency and caused disproportionate frustration among staff and families. These visits appear to be driven more by consequences of system design and structure than by family members' decision making. Mistrust of primary care services was not a strong family decision-making factor; the study's setting may have limited its ability to capture such data. Recommended system changes to lower barriers to primary care include expanded office hours, subsidized staffing for offices in medically underserved areas, and lowering barriers to sick care.
authors.affiliation: Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA. Nancy_chin@urmc.rochester.edu
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Chin
authors.forename: Julius G
authors.initials: JG
authors.lastname: Goepp
authors.forename: Timothy
authors.initials: T
authors.lastname: Malia
authors.forename: LeWanza
authors.initials: L
authors.lastname: Harris
authors.forename: Armin
authors.initials: A
authors.lastname: Poordabbagh
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D009518:New York; D010372:Pediatrics; D010564:Personnel, Hospital / Q000523:psychology*; D011203:Poverty; D012720:Severity of Illness Index