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Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium

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Abstract

Introduction

The nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (<15 years) attending the ED in 12 Belgian hospitals during 2 weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9 % (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95 % confidence intervals are respectively—1.7 (1.3–2.0), 1.7 (1.3–2.2), 1.5 (1.1–2.2), 1.5 (1.2–1.9), and 0.6 (0.5–0.8).

Conclusions

Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.

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Acknowledgments

This article is loosely based on a poster presentation given by N.B. at the 14th Annual European Congress of the International Society of Pharmacoeconomics and Outcomes Research in Madrid (5–8 November 2011), at the 40th Annual Congress of the Belgian Pediatrics society in Brussels (24 March 2012), and a short oral presentation at the Congress of Medical and Chirurgical Societies of Pediatrics in Bordeaux (9 June 2012). The article draws on work carried out in Belgian Paediatric Short Stay Study (BePASSTA) project funded by the Federal Ministry of Public Health. The views expressed are not necessarily those of the Ministry. We thank Isabelle van den Brempt and Anne Clercx from Federal Ministry of Public Health for constructive feedbacks and all the BePASSTA Collaborators (Marc Alexander, Philippe Alliet, Myriam Azou, Armando Barillari, Yves Bernard, Patrick Biliet, Sonja Braeken, Heidi Capiau, Georges Casimir, Kristina Casteels, Sarah Clavier, Stephan Clément de Cléty, Sara Debulpaep, Denise Deliège, Frederic De Meulder, An Demol, Kelly De Vriese, Guido de Wilde, Sabine Jespers, Célestin Kaputu, Chantal Lenaerts, Eric Luyckx, Jean-Paul Misson, Didier Moulin, Katleen Poschet, Roxane Rossignol, Els Sercu, Sandrina Timsonet, Anne-Marie Tomat, Rob Vandenover, Christel Van Geet, Collette Vanhelleputte, Gaston Verellen, and Pierre Vincke).

Funding

This study is funded by the Belgian Federal Ministry of Health.

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Correspondence to N. Benahmed.

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Benahmed, N., Laokri, S., Zhang, W.H. et al. Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium. Eur J Pediatr 171, 1829–1837 (2012). https://doi.org/10.1007/s00431-012-1853-y

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  • DOI: https://doi.org/10.1007/s00431-012-1853-y

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