Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey

JoAnn Harrold; Mélissa Langevin; Nick Barrowman; Ann E Sprague; Deshayne B Fell; Katherine A Moreau; Thierry Lacaze-Masmonteil; Suzanne Schuh; Gary Joubert; Andrea Moore; Tanya Solano; Roger L Zemek; Pediatric Emergency Research Canada Network

doi:10.9778/cmajo.20180015

Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey

CMAJ Open. 2018 Sep 28;6(3):E423-E429. doi: 10.9778/cmajo.20180015. Print 2018 Jul-Sep.

Affiliations

¹ Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont. jharrold@cheo.on.ca.
² Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont.

Abstract

Background: Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits.

Methods: We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors.

Results: A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment.

Interpretation: Parents' reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help.