Kate Orville, MPH
Noel Rees, MPA
University of Washington
Medical Home Leadership Network
Why do some families bring their children to the Emergency Department (ED) when their primary care office is open or available by phone? Reducing potentially avoidable ED visits is a focus for the Pediatric Transforming Clinical Practice Initiative (P-TCPi) in order to not only save costs but ensure children are being cared for in a timely manner by medical home clinicians who know them and their health history.
With P-TCPI funding, staff from the Center for Children with Special Needs (CCSN) helped two pediatric clinics (Northwest Pediatric Clinic and South Sound Pediatrics) pilot focus groups with parents and caregivers of patients who had been to the ED to better understand family decision-making around urgent medical concerns. CCSN staff developed the questions and process in collaboration with the pediatricians, P-TCPI public health nurse Regional Care Facilitators, Medical Home Partnerships Project staff and parents and P-TCPI staff.
The two focus groups explored questions in three areas:
- Knowledge about what to do when the clinic was closed or parent was unsure if it was an emergency
- Experience contacting clinic with an urgent question or concern
- Experience the last time they went to the ED with their child
Awareness varied among parents about both the hours and availability of the pediatric practice as well as urgent care options. Many parents praised the availability and flexibility of clinic clinicians. If parents did not know what to do, they would generally call the practice. Most but not everyone reported receiving a quick call back. There were sometimes inconsistencies from the clinic, Emergency Medical Technicians and hospitals about where the child should go for care, even for parents calling about the same condition, which was frustrating and sometimes scary for parents.
Parents generally reported bringing their children to the ED for immediate needs like breathing difficulties. Parents expressed a desire to better understand in advance where to go for care if something arose related to a child’s health condition or where to go based on the child’s symptoms. Things parents wished they had known in advance of going to the ED were: the wait time, that IVs are mandatory for pediatric patients, and that they would need enough of any medicine to last through to when pharmacies reopened after the weekend (i.e. Don’t leave the hospital without filling the prescription).
Recommendations from parents:
- Inform parents of the “why” behind clinic practices. For example, if it is clinic policy that a nurse needs to call back the parent after an ED visit, let the parent know why.
- Offer more after-hours availability.
- If there is a choice of more than one ED to go to, let parents know if one is better equipped for pediatric patients.