Nonurgent emergency-department care: analysis of parent and primary physician perspectives.
OBJECTIVE
To better understand parental decisions to seek care for their children and physician perceptions of parents' decisions to seek nonurgent emergency-department care.


METHODS
In-depth interviews of 26 parents of children and 20 primary care physicians of the same children presenting for nonurgent care at a children's hospital emergency department were completed. Parent accounts of events that preceded the emergency-department visit were coded and qualitatively analyzed for themes. Physician evaluations of the accounts of events and parental decisions were ascertained through interviews with primary care physicians, who also described their practice characteristics. The parent/physician analyses allowed for an investigation of all aspects of the child's care and were designed to reveal differences between parent and physician beliefs.


RESULTS
Parents believed that they acted appropriately, and physicians approved of parents' decisions. Four main themes emerged: (1) immediate reassurance that their children are safe from harm is critical to parents' decisions; (2) primary care offices lack specific tests and treatments that parents and physicians believe may be necessary, regardless of whether they are actually needed; (3) discrepancies exist between physician and parent perceptions of adequate communication and access; and (4) nonurgent emergency-department visits are not perceived as a significant enough breach in continuity of care by physicians and parents to warrant any concern.


CONCLUSIONS
When individual interviews were evaluated, neither parents nor primary care physicians saw nonurgent emergency-department visits as a significant enough problem to warrant any change in physician care practices or parent care-seeking behavior.
Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. dbrousse@mcw.edu
David C
DC
Brousseau
Mark R
MR
Nimmer
Nichole L
NL
Yunk
Ann B
AB
Nattinger
Ann
A
Greer
D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires