Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Julianne Ossege

Clinical Mentor

Dr. Patricia Howard

Committee Member

Dr. Judith Daniels

Abstract

Background: The use of emergency room services for primary care issues is an ongoing problem. The incidence is higher in the Medicaid population and is associated with emergency room overcrowding and excessive medical costs.

Purpose: The purpose of this study was to explore the extent of and the details surrounding non-acute emergency room visits in a pediatric population within an urban primary care clinic.

Methods: This was a two-part descriptive study with both quantitative and qualitative components. A retrospective chart review of this facility’s ER data constituted the quantitative descriptive part of the study. The qualitative arm of the study included semi-structured interviews with ER providers that were conducted to explore their perceptions on ER use within this population. Interviews were attained during observation experiences during their work shifts and were later grouped by common themes.

Results: There was a higher incidence of ER visits among the African-American (44%) and Hispanic (30%) populations, and with visits outside of normal clinic hours. The most common chief complaint was fever. The most common diagnoses fell within the respiratory system (26%). Themes from the provider interviews included the need for caregiver reassurance, patient and system level concerns, and provider solutions.

Conclusion: Implications for practice include a culturally relevant health initiative on the management of fever, and increased access to after-hours primary care.

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