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Analysis of factors conditioning inappropriate visits in a paediatric emergency department

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Abstract

Recent studies estimated that about 20–30% of visits in a paediatric emergency department (PED) are inappropriate. Nonurgent visits have been negatively associated with crowding and costs, causing longer waiting and dissatisfaction among both parents and health workers. We aimed to analyze possible factors conditioning inappropriate visits and misuse in a PED. We performed a cross-sectional study enrolling children accessing an Italian PED from June 2022 to September 2022 who received a nonurgent code. The appropriateness of visits, as measured by the “Mattoni SSN” Project, comprises combination of the assigned triage code, the adopted diagnostic resources, and outcomes. A validated questionnaire was also administered to parents/caregivers of included children to correlate their perceptions with the risk of inappropriate visit. Data were analyzed using independent-samples t-tests, Wilcoxon-Mann–Whitney tests, chi-square tests, and Fisher’s exact tests. The factors that were found to be associated with inappropriate visits to the PED were further evaluated by univariable and multivariable logistic regression analyses. Almost half (44.8%) of nonurgent visits resulted inappropriate. Main reasons for parents/caregivers to take their children to PED were (1) the perceived need to receive immediate care (31.5%), (2) the chance to immediately perform exams (26.7%), and (3) the reported difficulty in contacting family paediatrician (26.3%). Inappropriateness was directly related to child’s age, male gender, acute illness occurred in the previous month, and skin rash or abdominal pain as complaining symptoms.

     Conclusion: This study highlights the urgent need to finalize initiatives to reduce misuse in accessing PED. Empowering parents’ awareness and education in the management of the most frequent health problems in paediatric age may help to achieve this goal.

What is Known:

• About 20–30% of pediatric urgent visits are estimated as inappropriate.

• Several factors may be associated with this improper use of the emergency department, such as the misperception of parents who tend to overrate their children’s health conditions or dissatisfaction with primary care services.

What is New:

• This study evaluated almost half of pediatric emergency department visits as inappropriate adopting objective criteria.

• Inappropriateness was directly related to the child’s age, male gender, acute illness that occurred in the previous month, and skin rash or abdominal pain as complaining symptoms. Educational interventions for parents aimed at improving healthcare resource utilization should be prioritized.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Division of Pediatrics, University Hospital of Udine, P.zzale S. Maria della Misericordia, 15. 33100, Udine, Italy

    Ilaria Liguoro, Chiara Pilotto & Paola Cogo

  2. Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy

    Yvonne Beorchia, Luigi Castriotta & Antonio Pedduzza

  3. Department of Medicine (DAME), School of Nursing, University of Udine, Udine, Italy

    Antonella Rosso

  4. Department of Medicine (DAME), University of Udine, Udine, Italy

    Paola Cogo

Authors
  1. Ilaria Liguoro
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  4. Antonella Rosso
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  5. Antonio Pedduzza
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Contributions

I.L. wrote the first draft of the manuscript and led the project. A.R. collected data. Y.B. and L.C. performed the whole statistical analysis. Y.B. also prepared tables and supplementary material. Y.B, L.C., A.P., C.P. and P.C. critically revised the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Ilaria Liguoro.

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Ethical approval

The study was approved by the local International Review Board (IRB-DAME Prot. IRB 86/2022—Tit III cl 3 fasc. 8/2022) in accordance with the Declaration of Helsinki.

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The authors declare that they have no conflicts of interest.

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Communicated by Peter de Winter

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Liguoro, I., Beorchia, Y., Castriotta, L. et al. Analysis of factors conditioning inappropriate visits in a paediatric emergency department. Eur J Pediatr 182, 5427–5437 (2023). https://doi.org/10.1007/s00431-023-05223-6

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  • DOI: https://doi.org/10.1007/s00431-023-05223-6

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