Abstract
Background: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians). Results: Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described “erring on the side of caution” when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, “erring on the side of caution” was also identified as was managing “parental anxiety” and acting on “gut instinct”. Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service. Conclusions: The study of parent and referring clinician decision-making prior to a hospital admission can identify “teachable moments” where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as “parental anxiety”.
Highlights
The number of paediatric emergency hospital admissions has risen in recent years in countries including the UK [1,2], Sweden [3] and Denmark [4]
This was a qualitative study where audio-recorded, semi-structured interviews were conducted with the parents of children who had had an emergency admission hospital, clinicians who refer acute medical paediatric admissions and clinicians working in an acute medical paediatric receiving unit
“ . . . we do send lots home very quickly so you could argue that they didn’t need to be admitted but I think part of the just being seen, being assessed and reassured is part of the process.” (Doctor D). This qualitative study identified factors which parents and both referring and receiving clinicians consider during the decision-making process leading to a hospital admission
Summary
The number of paediatric emergency hospital admissions has risen in recent years in countries including the UK [1,2], Sweden [3] and Denmark [4]. There are several possible explanations for the rise in acute medical paediatric admissions, which broadly include changes in patient/parent health-seeking behaviour and changing practice in healthcare, both in the community and in the hospital. The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians).
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