High-users of Pediatric Emergency Room Department: who, how and why
Introduction: The number of visits to emergency departments has increased over time, and Portugal has the higher number of admissions per capita. The aims were to characterize the high-user population of a level II hospital (≥10 admissions/year), identify the profile of the high-user and develop strategies to decrease the possible wrongful access.
Methods: Retrospective, case-control study. Children under 18 years old at the end of 2017 were selected. Controls were considered children with ≤three admissions. In the statistical analysis was considered p≤0.005
Results: There were 66 children identified as high users (0,7% of the total users, responsible for 810 admissions). Of these, 66.7% was younger than three years old and 40% were chronic patients. Three per cent were preceded by a primary care consultation/Saúde 24, 70% were non urgent, and only 8% were admitted to the infirmary. The control group had a median of eight years old, higher use of primary care consultation/Saúde 24 (20%) and 80% used the emergency room for non-urgent motives.
Discussion: In both groups the emergency room is used as the main form of access to healthcare, the utilization of primary care consultation was low and the motives non-urgent. Young age (OR=6,75) and chronic disease (OR=4.69) were risk factors to higher use. Approach to primary care services, further teaching of which symptoms need hospital evaluation and the creation of other access paths to chronic patients may help to restrain the unnecessary use.
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