Prolonged Wait Times for Primary Care a Key Reason Parents Use Emergency Departments

Nancy A. Melville

October 06, 2010

October 6, 2010 (Las Vegas, Nevada) — The undesirable prospect of a long day in their primary care provider (PCP)'s waiting room drives many parents of sick children to opt for their local hospital's emergency department (ED), according to research presented here at the American College of Emergency Physicians 2010 Scientific Assembly.

Researchers surveyed 436 parents or caregivers of children brought to a community teaching hospital between December 2009 and March 2010. They found that nearly half of children presenting to the ED during regular office hours represented "avoidable" visits made by families that had access to PCPs.

As many as 96% of caregivers had PCPs, but the majority (58%) did not know their PCP's hours, and 24% could not even recall the PCP's name.

The study found that 63% of caregivers cited prolonged wait times at their PCP's office as the reason they came to the ED. Significant associations were made between avoidable visits and young age of the child (= .04) and not knowing the PCP's office hours (P = .007).

"Prolonged wait times in PCP offices and lack of knowledge of office hours are significant contributors to avoidable ED visits," said Vaishali Bansilal, MD, from the Brooklyn Hospital Center, in New York, and a coauthor of the study.

"It's clear that merely assigning a PCP does not reduce avoidable emergency department use unless caregivers are appropriately educated to access their services," Dr. Bansilal reported.

The study defined avoidable ED visits as cases in which "the patient's initial complaint, medical history, presenting signs and symptom, work-up or therapy given in the ED, and discharge diagnosis indicated that immediate care was not required within 12 hours." An unavoidable ED visit was defined as all patients who did not fall into the avoidable category.

The results indicated that as many as 45% of visits (n = 196) were considered avoidable.

"The results showed that avoidable ED visits occur in nearly half the children presenting to the ED during office hours, despite having a PCP," Dr. Bansilal said.

Overcrowding in EDs remains a critical issue, but the determination of what constitutes an avoidable visit has been a point of contention, according to Jill M. Baren, MD, director of pediatric emergency medicine education in the Department of Emergency Medicine at the Hospital of the University of Pennsylvania in Philadelphia, and moderator of the session at which Dr. Bansilal presented the study findings.

"Categorizing emergency department visits as avoidable really shouldn't be done in a retrospective fashion," said Dr. Baren.

Such characterizations can fail to take into account a host of legitimate factors that steer a caregiver to the ED, she explained.

"When people seek emergency care, particularly parents, they often truly believe their child could have a life-threatening issue."

"Despite this, do the results of this study mean that we should keep allowing these behaviors? No, but the implications are such that we need to do a better job of educating people about what an emergency is and to give them realistic alternatives for timely and accessible care," she asserted.

"Don't be lulled into a false sense of security that assigning a primary care doctor results in better access, as this study illustrates," Dr. Baren cautioned.

Dr. Bansilal and Dr. Baren have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2010 Scientific Assembly: Abstract 9. Presented September 28, 2010.

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