Why do parents present to the Paediatric Emergency Department with conditions suitable for management in less acute settings? A Qualitative Study

OBJECTIVE: To determine the factors influencing attendance at a Paediatric Emergency Department with conditions suitable for management in less acute settings. METHODS: Semi-structured interviews exploring parental decision-making processes surrounding care-seeking behaviours in urgent situations were undertaken with parents of children allocated to the two lowest triage categories at a type-1 urban Paediatric Emergency Department over two 2-week periods. RESULTS: All parents expressed a desire to access care from the most appropriate service for their child in unscheduled situations. A number of factors influenced parental perceptions of appropriateness: (1) perceptions concerning the urgency or severity of a condition; (2) uncertainty regarding their assessment of the severity or urgency of a problem; (3) the possibility that a condition may require resources available solely at the Paediatric Emergency Department; and (4) awareness of alternative services. Parents reported that previous utilisation of alternative services, which lead to them being referred onwards to the Paediatric Emergency Department, influenced their decision to attend the Paediatric Emergency Department on this occasion. CONCLUSION: Parental uncertainty and a low tolerance of risk among parents and healthcare professionals increases the likelihood of emergency department attendance. Parents are likely to continue to utilise the Paediatric Emergency Department for minor conditions. Future strategies should focus on improving outcomes for children with non-urgent problems who access care at the emergency department rather than discouraging utilisation.