title: Understanding decisions leading to nonurgent visits to the paediatric emergency department: caregivers' perspectives.
abstract: BACKGROUND
  A significant percentage of paediatric emergency department (ED) attendances worldwide are nonurgent, adversely affecting patient outcomes and healthcare systems. This study aimed to understand the reasons behind nonurgent ED visits, in order to develop targeted and effective preventive interventions.
  
  
  METHODS
  In-depth interviews were conducted with 49 caregivers to identify the decision-making factors related to taking children to the ED of KK Women's and Children's Hospital, Singapore. Interviews were carried out in the emergency room of the hospital after the children had been diagnosed with nonurgent conditions by the attending physician. Interview transcripts were analysed based on grounded theory principles.
  
  
  RESULTS
  The demographics of our study cohort were representative of the target population. The main reasons given by the caregivers for attending paediatric EDs included perceived severity of the child's symptoms, availability of after-hours care, perceived advantage of a paediatric specialist hospital and mistrust of primary care physicians' ability to manage paediatric conditions. Insurance or welfare was a contributing factor for only a small portion of caregivers.
  
  
  CONCLUSIONS
  The reasons provided by Singaporean caregivers for attending paediatric EDs were similar to those reported in studies conducted in Western countries. However, the former group had a unique understanding of the local healthcare system. The study's findings may be used to develop interventions to change the knowledge, attitudes and behaviours of caregivers in Singapore.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Phek Hui Jade
authors.initials: PH
authors.lastname: Kua
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.
authors.forename: Li
authors.initials: L
authors.lastname: Wu
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: E-Lin Tessa
authors.initials: EL
authors.lastname: Ong
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Zi Ying
authors.initials: ZY
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Jinmian Luther
authors.initials: JL
authors.lastname: Yiew
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Xing Hui Michelle
authors.initials: XH
authors.lastname: Thia
authors.affiliation: Office of Clinical Sciences, Duke-NUS Graduate Medical School Singapore, Singapore.|Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore.
authors.forename: Sharon Cohan
authors.initials: SC
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000628:therapy; D003657:Decision Making; D004630:Emergencies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004844:Epistaxis / Q000628:therapy; D005220:Fathers; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D010342:Patient Acceptance of Health Care; D010372:Pediatrics / Q000458:organization & administration*; D012141:Respiratory Tract Infections / Q000628:therapy; D012846:Singapore
keywords: nonurgent paediatric emergency department attendance