ReviewA qualitative systematic review of the reasons for parental attendance at the emergency department with children presenting with minor illness
Introduction
The demand for urgent healthcare services is increasing, and the pressure on Emergency Department (ED) is of significant concern globally [1]. EDs are visited annually by almost 5 million children in England, United Kingdom (UK) [2]. There are diverse rates of non-urgent ED visits internationally ranging from 39.9% in Belgium [3], 40% in England [4], 52.8% in Australia [5], 57% in Italy [6] and 58% in the United States of America (USA) [7] suggesting the international significance of ED paediatric attendance. The term ‘minor illness’ refers to non-urgent cases of common childhood illness which can be treated by simple medication or which need no treatment. Carey [8] defined acute minor illness as ordinary health problems, for example, non-severe but prevalent respiratory and gastrointestinal infections in children which do not require admission. The usage of EDs by patients with minor illness is an important and still unresolved problem causing a burden to health services [9].
Increased usage of ED causes complex issues e.g. patient density, increased workload [3], increased cost, raised staff attrition [5], and risk to the quality of care in ED. Consequences of using ED for non-urgent conditions include patient dissatisfaction, demand on ED staff, longer waiting times and delays in care [10], [11], [12]. Children presenting with a minor illness as self-referrals can often be appropriately and safely managed in a primary care setting [13], [14]. However, there is evidence that some parents do not attempt contact with their GP prior to emergency department attendance [3], [13].
Evidence to date focuses on parental choices e.g. Jaarsma-Van Leeuwen et al. [15] and Shearer et al. [16], however to date no qualitative systematic review has focused on parental reasons for visiting ED in this sub-group.
This systematic review identifies parental reasons for visiting ED for their children presenting with minor illness via thematic synthesis of qualitative data.
Section snippets
Methods
A qualitative systematic review was conducted against inclusion/exclusion criteria (Table 1) according to PRISMA guidance [17]. No restrictions were placed on designs of studies, publication date or country of origin. ‘Parents’ are defined as anyone who has a child or children aged <18 years without considering gender and parental age to minimise selection bias [18]. Studies published in English were considered for inclusion. The PICo framework was applied to formulate the review question (Table
Study selection
The searches yielded 471 studies and citations were exported to EndNote X6 reference manager software and duplicates were removed. A PRISMA flow diagram of the study selection process is presented in Fig. 1. Rationale for exclusion at full-text screening are presented (Table 5).
Study characteristics
The 4 included studies were published between 2003 and 2010; all included studies were conducted in the USA [20], [21], [22], [23]. A range of qualitative methodologies were embraced; a prospective mixed-method study
Discussion
The findings of this qualitative systematic review highlight the diversity of determinants that lead parents to attend an ED with children presenting minor illness. Novel themes such as ‘ethnic differences’, ‘hereditary anxiety’, ‘taking it off our hands’, ED as a ‘magical place’ have emerged.
The review findings support that ED attendance in this sub-group is a multi-faceted complex issue. Parental psychological impact on ED attendance [20], [22], [23] was significant in this review. In
Conclusion
This is the first known qualitative systematic review examining parental attendance in this area, which should be of interest to emergency care reformers, urgent care commissioners, researchers and ED clinical staff. This review further informs understanding of parental rationale for visiting ED for childhood minor illness. Parental reasons for visiting ED with children presenting with minor illness were identified. These are parents’ psychological impact, dissatisfaction with primary
Ethical statement
Not applicable.
Funding source
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Master’s Degree funding was provided by Republic of Turkey Ministry of National Education.
Conflicts of interest
The reviewers declared that there is no conflict of interest. This project was submitted as Ahmet Butun’s MSc dissertation in Advanced Nursing at the University of Nottingham.
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