Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium.
BACKGROUND
The nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (<15 years) attending the ED in 12 Belgian hospitals during 2 weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9 % (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95 % confidence intervals are respectively-1.7 (1.3-2.0), 1.7 (1.3-2.2), 1.5 (1.1-2.2), 1.5 (1.2-1.9), and 0.6 (0.5-0.8).


CONCLUSIONS
Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.
CREGISI (Research Center for Health Economics, Health Facilities Management and Nursing Sciences), School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium. nadiaseurynck@yahoo.fr
N
N
Benahmed
S
S
Laokri
W H
WH
Zhang
N
N
Verhaeghe
J
J
Trybou
L
L
Cohen
A
A
De Wever
S
S
Alexander
D001530:Belgium; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D010290:Parents / Q000523:psychology; D010343:Patient Admission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation