Abstract
Objective: Inappropriate use of the emergency department (ED) represents a major worldwide issue both in pediatric and adult age. Herein, we aim to describe features of pediatric visits to the ED of Salerno University Hospital and to evaluate parental reasons behind the decision to walk in.Materials and Methods: We performed a retrospective observational study evaluating ED encounters for children from January 2014 to December 2019. The appropriateness of visits was measured with a national tool assessing every ED encounter, namely, “the Mattoni method,” which consists of the combination of the triage code assigned, the diagnostic resources adopted, and the consultation outcomes. Moreover, 64 questionnaires were collected from a sample of parents in the waiting rooms in January 2020.Results: A total number of 42,507 visits were recorded during the study period (19,126 females; mean age ± SD: 4.3 ± 3.8 years), the majority of whom were inappropriate (75.8% over the considered period; 73.6% in 2014; 74.6% in 2015; 76.3% in 2016; 76.7% in 2017; 77.9% in 2018; 75.5% in 2019). Most of the inappropriate consultations arrived at the ED by their own vehicle (94.4%), following an independent decision of the parents (97.2%), especially in the evening and at night on Saturdays/Sundays/holidays (69.7%). A multivariate analysis revealed the following: patients of younger age (OR: 1.11, 95% C.I. 1.06–1.16; p < 0.0019), night visits (OR 1.39; 95% C.I.: 1.32–1.47; p < 0.001), patients living in the municipality of Salerno (OR 1.28; 95% C.I.: 1.22–1.34; p < 0.001), weekend day visits (OR 1.48; 95% C.I.: 1.41–1.56; p < 0.001), and independent parental decision without previous contact with primary care pediatrician (OR 3.01; 95% C.I.: 2.64–3.44; p < 0.001) were all significant independent predictors of inappropriate consultation. The most frequent trigger of ED encounters was fever (51.4%). Hospital admission made up 17.6% of all consultations. The questionnaire showed that most parents were aware of the lack of urgency (20.3%) or minor urgency (53.1%) of the visit. The reasons for walking in were the impossibility to receive a home consultation (70%), the difficulty of contacting their family pediatrician during weekends and holidays (54.4%), as well as the search for a quick, effective, diagnosis and therapy (48.4%).Conclusions: The study suggests a highly inappropriate use of ED for children in our region. This issue deserves considerable attention by health care system leaders in order to optimally integrate hospitals and primary care.
Highlights
An emergency department (ED) (Emergency Department) is the part of a hospital dedicated to recently injured or sick people who need prompt treatment
This unsteady balance between unnecessary primary care consultations wrongly addressed in the ED and available resources reveals an overcrowding condition into emergency rooms, which negatively affects both the patients and hospital staff [1, 2]
Appropriateness was rated according to the Mattoni method, a nationwide system of classification for appropriate encounters to ED expressed as a ratio of non-urgent patients discharged from the ED for whom no diagnostic test was required over the total of ED consultations [5]
Summary
An ED (Emergency Department) is the part of a hospital dedicated to recently injured or sick people who need prompt treatment. Notwithstanding its distinctive role, through the years this area has witnessed a high increase of unnecessary visits that should instead be dealt with by other appropriate primary care services, ideally available and reachable in our communities This unsteady balance between unnecessary primary care consultations wrongly addressed in the ED and available resources reveals an overcrowding condition into emergency rooms, which negatively affects both the patients (through a collateral increase in waiting time, lack of confidentiality, and efficiency) and hospital staff (the higher risk of burnout, lower motivation, and professional satisfaction, increase in violence episodes toward health care professionals for long waits) [1, 2]. In December 2003, Italian central and regional governments agreed on “Mattoni SSN” project with the aim of evaluating the appropriateness of every emergency room visit by its triage code assigned, the diagnostic resources adopted, and consultation outcomes [5]
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