Practice Characteristics That Influence Nonurgent Pediatric Emergency Department Utilization

Objective The goal of this study was to determine what characteristics of a primary care pediatric practice are associated with nonurgent use of the pediatric emergency department (PED). Methods Primary care practice characteristics were prospectively collected from 33 practices. Nonurgent and urgent visits to the PED for patients from these practices were analyzed retrospectively. A discriminant analysis classification model was used to identify practice characteristics that were associated with nonurgent versus urgent utilization of the PED. Results Patients in the network of 33 practices accounted for 31 076 visits to the PED during the 12-month study period, 47% of which were classified as nonurgent. Based on the discriminant analysis classification model, discriminant patterns that predict the frequency of nonurgent utilization included the percentage of patients with Medicaid, total available sick slots to see patients per physician, closer distance to the PED, whether or not the nurse triage line notified all on-call physicians of disposition to the PED, whether it is practice policy to accept all walk-in sick visits, and ability of practice to have same-day turnaround of laboratory tests. Conclusions Nonurgent utilization of the PED by patients in a specific primary care practice can be predicted based on discriminant practice characteristics, several of which may be modifiable. Use of these predictive rules can be used to optimize pediatric services and policy to help mitigate the high volume of PED nonurgent visitation. Focused interventions on practice characteristics of significance may help reduce PED overcrowding and improve continuity of care.