Why do children present to emergency departments? Exploring motivators and measures of presentation appropriateness for children presenting to a paediatric emergency department

Aim: To compare the parental motivators and referring general practitioner's (GP's) reasons for advising emergency department (ED) attendance with the assessment of ED medical staff. To compare ED clinician opinion with other published methods that have attempted to define ‘primary care suitable' presentations to the ED. Methods: A prospective observational study and series of surveys regarding the attendance of children presenting to a single tertiary paediatric ED. Surveys were distributed to the treating ED clinician, the child's parent/guardian, and the referring GP. Results between the three groups were analysed and compared. Results: There were a total of 1069 presentations during the study period. Six hundred (58.4%, 95% CI 55.3–61.4%) presentations were judged as ‘ED appropriate’ by the treating ED clinician. When compared with methods used to retrospectively judge whether ED patients are considered ‘primary care suitable’, ED clinicians disagree between 22.4 and 38.8% of the time. For patients who presented directly to ED, 85.6% did so for a medical reason, whilst 32.1% did so for a GP access reason. Being referred by a GP improved the ED clinicians’ opinion of the appropriateness of the presentation (49.2 vs. 73.9%, P < 0.05). Conclusions: We caution that many strategies attempting to ‘solve’ the issue of increasing ED attendances by paediatric patients have been driven by opinion, and a better understanding of the motivators that drive this behaviour is needed. We believe the solution to increasing utilisation of EDs by children must be a balanced approach that addresses community expectations and appropriately resources EDs.