Nonurgent Reasons Research Articles

Out-of-pocket fees for health care in Australia: implications for equity.

Out-of-pocket fees for health care in Australia: implications for equity.

Evaluation of the patients admitted to the pediatric emergency service: Cross-sectional analysis of the pediatric emergency and trauma clinic of a tertiary training hospital in Turkey.

This study aims to carry out a cross-sectional analysis of the applications during three months to the Pediatric Emergency Service of İzmir University of Health Sciences, Tepecik Training and Research Hospital and determination of demographical features and distribution of cases in line with provided data and planning the positive changes and innovations in the current service and functioning of the Pediatric Emergency Service. The file records of 46038 patients between the ages of 0-18 who applied to the University of Health Science, Tepecik Training and Research Hospital Pediatric Emergency Training Clinic were examined retrospectively in this study. A total of 46038 patients (53.6% male) applied to the emergency service. The average age was 7.07 for both genders. In the application, the average age of the patients with a history of trauma was 9.3, whereas the average age of the patients without a history of trauma is 6.7. While 82.7% of the patients was male with no trauma history, 86.9% was female without a history of trauma. When the application diagnoses were examined, the most common diagnosis was Upper Respiratory Infection (58.5%). More than half of the applications were monitored in the emergency observation unit (62.5%). When the patients were evaluated according to age groups, 49.2% of them were the children aged between 1-6. While 10.5% of the applicants were infants, and 38.7% were game children, it was noteworthy that the number of male patients was higher in the 1-6 age group, with 54.7%. There was no trauma in 49.5% of the cases. 78,3% of the cases were applied directly to the Paediatric Emergency. Secondly, 16.6% were to the Green Area-1 and Green Area-2. 98.2% of the cases were applied to the Emergency Service for ambulatory care. The 48.8% of the applications were made out of working hours. 97.6% of the cases were not hospitalized for the treatment and were addressed to home. The average staying period of the hospitalized cases in the Service was 4.53 days. Among applications, seven cases died. Most of the patients admitted to pediatric emergency service for non-urgent reasons which can be managed in primary care services.

Nonurgent Emergency Department Use by Pediatric Patients in the United States: A Systematic Literature Review.

Pediatric use of the emergency department (ED) for nonurgent reasons is common in the United States. Patients with nonurgent conditions can receive more appropriate, cost-efficient care in other settings. We conducted a systematic literature review to understand the breadth of factors that contribute to use of the ED for nonurgent conditions by pediatric patients in the United States. The literature search was conducted according to the PRISMA guidelines for systematic reviews and was guided by the social-ecological model for synthesis of articles. Published articles were identified through a search of Academic Search Ultimate, Google Scholar, and PubMed. All articles were organized and managed using Endnote software and screened for eligibility criteria before full-text review. The initial search yielded 679 articles with 530 articles remaining after the removal of duplicates. Of these, 31 articles were reviewed in full text with 19 remaining for the final analysis. All articles assessed individual-level factors, including parental perceptions of ED and health literacy. Additional findings of nonurgent use of the ED were shown to pertain to the organizational and public policy levels of the model, including primary care clinic and insurance characteristics. The findings of this review suggest tailored interventions to address parents'/caregivers' ED perceptions and health literacy in addition to access (ie, public policy).

The Body in Crisis: A Health Needs Assessment among Female Survivors of Interpersonal Violence.

When women who experience violence seek social services, they are looking to meet immediate needs: shelter, safety, and support. Seeking assistance as part of a crisis may inadvertently detract attention away from other critical needs. Literature illustrates the emotional and physical effects of violence on women's bodies, as well as their long-term health. While health may present as an urgent need in cases of serious injury, it is often overlooked in crisis-oriented service delivery systems. This study explored the experience with violence, health status, and holistic healthcare needs among women accessing interpersonal violence services in Texas. A tablet-based survey was conducted at a family justice center, rape crisis center, and emergency shelter among women (N = 99) in Fort Worth, Texas. Survey questions assessed the participants' demographic information, health status, health needs, healthcare utilization, barriers to accessing healthcare, and experience with interpersonal violence among participating women. Two-thirds of the sample reported suffering injuries from victimization experiences. More than half of the sample (62%) reported they went to the emergency room at least one time in the last 6months, with 11 women reported staying five or more nights in the hospital in the last 6months. Participants described urgent (e.g., advised by healthcare provider, too serious for a clinic) and non-urgent (e.g., not having another source of care, closest provider) reasons for using the emergency room. Roughly, half of the sample (50%) reported having at least three chronic conditions. This study illustrated that women seeking interpersonal violence related (IPV) services have multiple unmet needs and lack adequate access to physical and mental health care. Since the majority of the sample was living in poverty, there are multiple costs and investments in the participants' health that were forgone for their survival. This study provides data in support of the development of health-related services for IPV survivors.

Nonurgent Visits to the Pediatric Emergency Department before and during the First Peak of the COVID-19 Pandemic.

Background Nonurgent visits in pediatric Emergency Departments are a growing burden. In order to find predictors for those nonurgent visits, we performed a retrospective analysis of unscheduled visits at the Pediatric Emergency Department of the University Hospital of Bonn, Germany, in the year 2017. Additionally, we compared these findings to unscheduled visits during the first peak of the worldwide pandemic of the Coronavirus disease 2019, to see if there would be an effect on nonurgent pediatric Emergency Department attendances. Methods For our retrospective cohort study, we analyzed more than 5.000 visits at the pediatric Emergency Department of the University Hospital of Bonn, Germany, before and during the first peak of the ongoing worldwide pandemic of the Coronavirus disease 2019, particularly with regard to their urgency. Data included gender, age, zip code, urgency, and preexisting conditions. Results Our study shows that more than half of unscheduled pediatric Emergency Department visits (69%) at the University Hospital in Bonn are for nonurgent reasons, with short living distance being a factor to present children to a pediatric Emergency Department, even with minor complaints. During the first peak of the pandemic of the Coronavirus disease 2019, nonurgent visits decreased significantly, potentially due to hesitation to attend a pediatric Emergency Department with minor issues, fearing an infection with SARS-CoV-2 at the hospital. Conclusion Many people use pediatric Emergency Departments for nonemergency complaints. In order to address the reasons for nonurgent visits to pediatric Emergency Departments and to prevent parents from doing so, further studies and targeted education concepts for parents are needed.

Victims of Violence and Post-Discharge Adverse Events: A Prospective Modified Trauma Quality Improvement Program (TQIP) Study.

IntroductionTrauma patients frequently return to an emergency department (ED) soon after discharge; often for non-urgent reasons. Social factors contribute to higher ED usage. At present, there is no standardized system for reporting of ED visits and readmissions among trauma care. We hypothesized that victims of violent crime suffer from many early post-discharge adverse events that has not been captured by current methods.MethodsWe prospectively consented and enrolled injured patients from January 1st, 2019 to December 31st, 2019. We documented 30-day post-discharge events using post-discharge phone calls and detailed chart abstraction. Patients were categorized as victims of violence (VV) or unintentional traumatic injury (UT).ResultsDuring the study period, 444 patients were enrolled. Fifty-one (11.5%) were victims of violence and 393 (88.5%) experienced unintentional injuries. The VV patients were younger (40.10 vs 60.36; p<0.0001), and more predominantly male (92.16% vs 57.51%; p<0.0001). Total injury severity score (ISS), critical care length of stay (LOS), and total LOS were similar. VV patients were more likely discharged home (70.59% vs 55.47%; p=0.0403). They were significantly more likely to return to an emergency department (47.06% vs 23.16%; p<0.0005) and had more total number of ED visits per patient. Readmission rates, however, were not different (21.57% vs 16.28%; p=NS). The VV patients more frequently were underinsured (72.5%, vs 20.6%, p<0.005).DiscussionVictims of violence presented to the ED significantly more often, despite similar injury scores, LOS, and being of younger age. Of these patients, only 26.2% of ED presentations resulted in readmission, suggesting the majority of patient complaints may have been able to be managed in an office-based setting. VV had significantly more underinsured or subsidized patients. Victims of violence are vulnerable and may benefit from more resources provided in the early post-discharge period.

Characteristics of non-urgent visits in emergency department

Aim: In recent years, the number of patients using the emergency department is increasing and majority of these patients constitute non-emergency patients. In this study, it was aimed to examine the green field patients who applied to the emergency department of a tertiary hospital by non-urgent reasons and define the socio-demographic characteristics, the reasons for preferring the emergency department, to assess the rate of urgency defined by the participant, and to contribute to the literature by obtaining data for our country.Materials and Methods: This is a cross-sectional study in which the subjects were selected among the whole green area patients applied to emergency department in between 02 and 11 November 2018. Among these patients, the subjects who did not accept to be included to the study and didn’t fulfill the inclusion criteria were excluded. As a result, a total of 716 patients who accepted to be in the study and fulfilled the inclusion criteria were included to the study. Then, a questionnaire for the aim of assessing the socio-demographic characteristics and the reasons for preferring the emergency department, involving a scale to define the self-report of urgency were applied to those 716 volunteered patients.Results: In our study, 23.9 % of a total of 5644 patients applied to emergency department in between 02 and 11 November 2018 were grouped as non-urgent green area patients by the triage personnel. Of these green area patients those who accepted to be included to the study and fulfilled the inclusion criteria; 356 were female (49.7 %) and 360 were male (50.3 %). When the participants were evaluated according to their level of educations, 5.4 % were illiterate, 4.1 % were literate but had no school graduate, 30.6 % were primary education graduates and 13.4 % were university graduates. According to the reasons for choosing the emergency department, 48.2 % of the patients stated that they applied to the emergency department in need of emergency treatment, 22.5 % of the visitors declared that they were unable to get permission from their work in their working hours and 13.1 % of the visitors applied due to their opinion that things were progressing faster in the emergency department. In addition, the patients were asked to scale their urgency in a 10-point scale and the mean rate of urgency defined by the participants in the self-report scale was found to be 6 points (0-10) and negative correlation was observed between education levels and urgent levels.Conclusion: In this study, we obtained descriptive data about the green field patients who applied to the emergency department by non-urgent reasons, defined their socio-demographic characteristics, revealed the reasons for non-urgent applications to the emergency department, and assessed the self-rate of urgency defined by the participants. Since it can be predicted that the overcrowding generated by these non-urgent visits has negative effects and consequence on patients and employees; we consider that this study and similar studies may be helpful in describing the current problem, may help to solve the problem by contributing to the literature.

Rural–Urban Differences in Health Care Access and Utilization under the Medicaid Expansion

AbstractThe Affordable Care Act's Medicaid expansion ushered in substantial increases in enrollment in the public insurance program. I analyzed rural–urban differences in access to health insurance, financial access to primary care providers, use of preventive care, and use of emergency department for medical reasons that did not lead to hospitalization. Low‐income rural residents were found to have greater reduction in likelihood of uninsurance than their urban counterparts. While an increase in the likelihood of routine check‐ups was found to be significant only among rural residents, a decrease in the likelihood of repeated visits to the emergency departments for nonurgent reasons was only significant among the urban population. I highlight the importance of understanding rural experiences to reduce rural–urban health disparities.

Implicit Bias in Pediatrics: An Emerging Focus in Health Equity Research.

* Abbreviation: ED — : emergency department Despite large-scale investments in research, health policy, care delivery models, and medical school curricula, inequities along the continuum of child health care and health persist.1,2 The study “Racial and Ethnic Differences in Emergency Department Pain Management of Children with Fractures”3 in this issue of Pediatrics contributes new insights into the field of pediatric health equity research with a focus on pain in the emergency department (ED) setting. Goyal et al3 find that although racial and/or ethnic minority children were more likely to receive analgesics and achieve a ≥2-point reduction in pain, they were less likely to receive opioids and experience optimal pain reduction. This work builds on a well-established body of literature in adult care and an emerging evidence base in pediatrics demonstrating inequities in analgesic administration.4 Studies in pediatric EDs have demonstrated racial and/or ethnic disparities in analgesic management for children presenting with acute abdominal pain and appendicitis.5,6 The current study adds to the field by combining process and outcome measures in assessing analgesic management. As the authors and other researchers in the field have highlighted, there … Address correspondence to Jean L. Raphael, MD, MPH, Texas Children’s Hospital, 6701 Fannin St, Suite D.1540.00, Houston, TX 77030. E-mail: raphael{at}bcm.edu

Avoidable Emergency Department Visits: Differences between Texas and Washington Medicaid Enrollees

Administrative claims data from 2012 are used from Texas and Washington State to understand state differences in the likelihood of non-urgent emergency department utilization prior to the implementation of the Affordable Care Act. Texas is currently the largest state that has opted to not expand Medicaid. Washington State has expanded Medicaid, and it had more generous pre-expansion Medicaid income eligibility criterion compared to Texas. I find that emergency department use for non-urgent reasons was higher in Texas compared to the state of Washington in 2012. Additionally, in Texas, there was a disproportionately high demand for obstetric services that are typically provided in outpatient settings. Non-urgent emergency department demand was associated with disruption in Medicaid coverage in both states. In Texas, especially, Medicaid coverage disruption and rural area residency were associated with higher likelihood of emergency department use for emergent but primary care treatable reasons.

Understanding the Impact of Chronic Pain in the Emergency Department: Prevalence and Characteristics of Patients Visiting the Emergency Department for Chronic Pain at an Urban Academic Health Sciences Centre

ABSTRACT Background Canadians make approximately 16 million visits to the emergency department (ED) each year. ED visits for non-urgent reasons contribute to suboptimal patient care and ineffective resource use. Aims To estimate the proportion of ED visits related to chronic pain at our institution. Methods. We conducted a retrospective review of 1000 randomly selected ED visits at TOH during the 2012–2013 fiscal year (April 1, 2012 to March 31, 2013). Visits for chronic pain were identified using pre-defined criteria. Demographic and medical data were extracted from medical charts. Results 104 visits during this time period were related to chronic pain (10.4%; 95% CI: 8.2–12.6). All visits were from unique patients (i.e., no patients contributed more than 1 visit). Patients were predominantly women (71%), with a mean age of 45.9 years. Seventy-eight percent of patients had a primary care provider. The most common location of pain included the abdomen (24%), the head or face (21%), and the low back (21%). Only 5% of patients had consultation with a pain medicine specialist while 78% were awaiting a consultation. More than 2/3 of patients (71%) reported using opioids for their pain. Conclusion Presenting to the ED for chronic pain was found to occur among a sample of ED visits reviewed. This can result in ineffective care for patients with chronic pain. Cost-effective solutions to improve clinical outcomes and reduce ED use for chronic pain may yield significant improvements in health outcomes of patients and benefits for the health care system.

Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States.

For many children, the emergency department (ED) serves as the main destination for health care, whether it be for emergent or nonurgent reasons. Through examination of repeat utilization and ED reliance (EDR), in addition to overall ED utilization, we can identify subpopulations dependent on the ED as their primary source of health care. Nationally representative data from the 2010 to 2014 Medical Expenditure Panel Survey were used to examine the annual ED utilization of children age 0 to 17 years by insurance coverage. Overall utilization, repeat utilization (two or more ED visits), and EDR (percentage of all health care visits that occur in the ED) were examined using multivariate models, accounting for weighting and the complex survey design. High EDR was defined as having > 33% of outpatient visits in a year being ED visits. A total of 47,926 children were included in the study. Approximately 12% of children visited an ED within a 1-year period. A greater number of children with public insurance (15.2%) visited an ED at least once, compared to privately insured (10.1%) and uninsured (6.4%) children. Controlling for covariates, children with public insurance were more likely to visit the ED (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.40-1.73) than children with private insurance, whereas uninsured children were less likely (aOR = 0.64, 95% CI = 0.51-0.81). Children age 3 and under were significantly more likely to visit the ED than children age 15 to 17, whereas female children and Hispanic and non-Hispanic other race children were significantly less likely to visit the ED than male children and non-Hispanic white children. Among children with ED visits, 21% had two or more visits to the ED in a 1-year period. Children with public insurance were more likely to have two or more visits to the ED (aOR = 1.53, 95% CI = 1.19-1.98) than children with private insurance whereas there was no significant difference in repeat ED utilization for uninsured children. Publicly insured (aOR = 1.70, 95% CI = 1.47-1.97) and uninsured children (aOR = 1.90, 95% CI = 1.49-2.42) were more likely to be reliant on the ED than children with private insurance. Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and EDR. Demographic characteristics, including sex, age, income, and race/ethnicity were important predictors of ED utilization and reliance.

PreManage ED™ Evaluation in Hospitals of Alameda County, California

Background: In medically underserved markets, frequent utilization of the emergency department for nonurgent reasons suggests inadequate access to ambulatory care and contributes to suboptimal patient outcomes. Hospital-based interventions are challenging to implement because any single hospital has a limited view of a patient’s health story. To address this issue, PreManage ED™ (PMED), a data-sharing platform, has been implemented in 6 hospitals in Alameda County in Northern California –– 4 Sutter facilities and 2 Alameda Health System facilities. In the initial stage of the evaluation, we characterized PMED use and assessed user acceptance.

Connecting Emergency Department Patients to Primary Care.

Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or comparison group (n = 68) for a 12-month study designed to connect these patients to primary care offices. Evaluation was mixed quantitative/qualitative. Significantly more intervention participants attended at least 1 primary care visit 3 months after the intervention (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.06-6.02), though this difference was not significant by 12 months (OR, 1.74; 95% CI, 0.79-3.84). The intervention participants also did not have lower odds of returning to the ED for nonurgent reasons by the 12-month follow-up (OR, 1.27; 95% CI, 0.65-2.48). Patient-reported barriers to attending a primary care appointment were primarily social and health system-related factors. The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.

Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions.

Children with autism spectrum disorders (ASD) are more likely to have difficulties accessing health care compared to other children with special health care needs. National data based on parent report indicate that children with ASD are overutilizing emergency department (ED) services, but data on actual ED use has been limited to children with psychiatric diagnoses. This study examined factors associated with ED utilization (rate, urgency, and hospital admissions) among children with ASD compared to those without ASD. Data from an urban, tertiary children's hospital level 1 trauma center were examined retrospectively 2006-2009. Anderson's model of health services utilization served as the study framework. The NYU ED algorithm was used to predict nonurgent visits. Multivariate linear and logistic regression analyses were performed on the rate, urgency, and subsequent hospital admissions of these ED visits. There were 115,443 children 2-21 years old, accounting for a total of 157,902 visits. The top three reasons for visiting the ED for children with and without ASD were acute upper respiratory infections, viral infections and otitis media. Children with ASD had on average 0.26 more ED visits annually than children without ASD (p < 0.01) and were 2.6 % points more likely to have nonurgent visits; p < 0.01). Their visits were also less likely to result in hospital admissions (OR 0. 61; p < 0.01). Examination of predisposing, enabling, and reinforcing factors suggest that children with ASD were more likely to visit the ED and for nonurgent reasons.

Promoting an obesity education program among minority patients in a single urban pediatric Emergency Department (ED)

BackgroundThe purpose of this study was to assess the feasibility of the Emergency Department (ED) as a place for obesity education and to evaluate its impact on patient’s lifestyle modification.MethodsIn this study, children between 8 and 18 years of age, who presented to the ED for non-urgent reasons in a single urban hospital, were enrolled. Parents’ perception of their child’s diet and exercise were assessed prior to the intervention. Both parents and children attended a brief audio-visual presentation that provided educational information on age-appropriate diet and exercise. Following the intervention, the participants were asked about their impressions regarding the ED as a place to receive obesity education and whether they plan to make any changes in diet and exercise.ResultsOne hundred children and their parents participated in this study. Of these, 76 were Latino and 21 were African-Americans. The mean age was 14 years, and the mean body mass index (BMI) was 25.6. Following the intervention, 21 (100 %) of the African-American parents and 73 (98.6 %) of the Latino parents felt that the ED should provide obesity education. Eighteen (85.7 %) of the African-American parents and 72 (97.3 %) of the Latino parents planned to make changes in their child’s diet and exercise. Among the children, 21 (100 %) of African-American participants and 76 (100 %) of Latino participants reported that they found the audio-visual useful. Seventeen (81.0 %) of the African-American children and 73 (96.1 %) of Latino children stated learning new information from the intervention program.ConclusionsThis study suggests the ED may have a role in primary health promotion and obesity prevention. An ED-based intervention may be used to provide education about obesity prevention and has the potential to impact life style modifications, including diet and exercise.

Copayments and Emergency Department Use Among Adult Medicaid Enrollees

A number of state Medicaid programs have recently proposed or implemented new or increased copayments for nonemergent emergency department (ED) visits. Evidence suggests that copayments generally reduce the level of healthcare utilization, although there is little specific evidence regarding the effectiveness of copayments in reducing nonurgent ED use among Medicaid enrollees or other low-income populations. Encouraging efficient and appropriate use of healthcare services will be of particular importance for Medicaid programs as they expand under the Patient Protection and Affordable Care Act. This analysis uses national data from 2001 to 2009 to examine the effect of copayments on nonurgent ED utilization among nonelderly adult enrollees. We find that visits among Medicaid enrollees in state-years where a copayment is in place are significantly less likely to be for nonurgent reasons. Our findings suggest that copayments may be an effective tool for reducing use of the ED for nonurgent care.

Nonurgent Emergency Department Use During Pregnancy

INTRODUCTION: An examination of the relationship between sociodemographic factors and nonurgent use of the emergency department (ED) during pregnancy. METHODS: We conducted a cross-sectional study of postpartum women who delivered between June and August 2012. Consenting participants completed a demographic, obstetric, and emergency care questionnaire and validated health literacy screening tool. Additional data were collected from medical records. Our independent variables were race–ethnicity, insurance status, income, education, and primary language spoken. The main outcome variable was nonurgent ED use defined by reason for visit, number of resources used, and disposition. Odds ratios (ORs) and 95% confidence intervals (CIs) for nonurgent ED use were calculated using multivariable logistic regression. RESULTS: Two hundred thirty-three women consented and completed study materials. Of 197 participants using the ED, 44% (n=87) had at least one “nonurgent” visit. Younger age, Hispanic ethnicity, income less than $20,000 per year, government insurance, high school education or less, a primary language other than English, and missed prenatal care were all associated with increased odds of nonurgent use of ED care (P≤.05 for all). When we mutually adjusted for several of these factors, we found that Hispanic patients and patients with government insurance were more likely to use the ED during pregnancy for nonurgent reasons compared with non-Hispanic patients and patients with private insurance (OR 2.65, CI 1.1–6.37 and OR 5.53, 2.54–12.06, respectively). CONCLUSION: Several sociodemographic factors were associated with nonurgent ED use. Focusing on at-risk populations may assist with decreasing nonurgent ED use during pregnancy.

G24(P) Exploring the relationship between infectious disease and acute health seeking behaviour in the paediatric population

Aims In the United Kingdom, over four and a half million paediatric emergency care attendances were recorded in 2010/11: across developed healthcare economies there has been a dramatic rise in the number of children attending secondary healthcare for non-urgent reasons. The majority of paediatric medical illness consists of self-limiting childhood infections, which can be managed in the community. Despite this, record numbers of children and young people are admitted to hospital, with most admissions lasting less than 24 h. This work explores how infectious disease in the paediatric population impacts on developed economy acute healthcare, and how the utilisation of these services as first contact for children and their caregivers affects the spread of infectious diseases. Methods Literature searches in (i) NCBI PubMed using MeSH terms “Paediatrics”, “Paediatric Hospitals”, “Infection” and “Emergency Medicine” and (ii) Outbreak Database (an online database of nosocomial outbreaks). The results were hand sorted to include relevant papers and a thematic analysis performed along the themes of health-seeking behaviour and use of acute healthcare services for non-urgent care in paediatric infectious disease. Results Regarding the impact of paediatric infectious disease in acute healthcare provision, three main themes emerged: (i) “Can’t cope”: Lack of understanding of infectious disease and the impact of socioeconomic stressors; (ii) “Won’t cope”: Phobia of risk, uncertainty regarding infectious disease and the cult of convenience and (iii) “No Hope”: Barriers to primary and preventative healthcare and failure of trust in healthcare professionals. Acute healthcare attendance can propagate infectious disease via contact with acute healthcare workers, cohorting in the waiting room and as a result of unnecessary admission to hospital. Conclusions Families should be better supported by health visitor input and school education and by integration of primary and secondary care. Education in infectious disease for Paediatricians and General Practitioners will promote consistent messages regarding normal childhood illnesses. Debate is needed concerning mandatory vaccination of acute healthcare workers. New healthcare facilities need to be designed to allow for cohorting and separation of infectious cases, and more publicity given to hand and cough hygiene for children and their carers whilst in the acute healthcare setting.

Are Young Adults Using the Emergency Room for Non-urgent Reasons?

Are Young Adults Using the Emergency Room for Non-urgent Reasons?