title: Understanding Low-Acuity Visits to the Pediatric Emergency Department.
abstract: BACKGROUND
  Canadian pediatric emergency department visits are increasing, with a disproportionate increase in low-acuity visits locally (33% of volume in 2008-09, 41% in 2011-12). We sought to understand: 1) presentation patterns and resource implications; 2) parents' perceptions and motivations; and 3) alternate health care options considered prior to presenting with low-acuity problems.
  
  
  METHODS
  We conducted a prospective cohort study at our tertiary pediatric emergency department serving two provinces to explore differences between patients with and without a primary care provider. During four, 2-week study periods over 1 year, parents of low-acuity visits received an anonymous survey. Presentation times, interventions, diagnoses and dispositions were captured on a data collection form linked to the survey by study number.
  
  
  RESULTS
  Parents completed 2,443 surveys (74.1% response rate), with survey-data collection form pairs available for 2,146 visits. Overall, 89.7% of respondents had a primary care provider; 68% were family physicians. Surprisingly, 40% of visits occurred during weekday office hours and 27.3% occurred within 4 hours of symptom onset; 67.5% of those early presenters were for injuries. Few parents sought care from their primary care provider (25%), health information line (20.7%), or urgent care clinic (18.5%); 36% reported that they believed their child's problem required the emergency department. Forty-five percent required only a history, physical exam and reassurance; only 11% required an intervention not available in an office setting. Patients without a primary care provider were significantly more likely to present during weekday office hours (p = 0.003), have longer symptom duration (p<0.001), and not know of other options (p = 0.001).
  
  
  CONCLUSIONS
  Many parents seek pediatric emergency department care for low-acuity problems despite their child having a primary care provider. Ensuring timely access to these providers may help reduce pediatric emergency department overuse. Educational initiatives should inform parents about low-acuity problems and where appropriate care can/should be accessed.
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Ken J
authors.initials: KJ
authors.lastname: Farion
authors.affiliation: Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Megan
authors.initials: M
authors.lastname: Wright
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Neto
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Karwowska
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Tse
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Reid
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Mona
authors.initials: M
authors.lastname: Jabbour
authors.affiliation: Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Poirier
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Moreau
authors.affiliation: Departments of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Clincial Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Barrowman
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D011446:Prospective Studies; D063128:Tertiary Health Care