Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: A qualitative study of parents perspectives

Abstract

Background: Non-urgent visits to Emergency Departments (EDs) are on the increase, and the pressure on EDs is a significant concern globally. The use of EDs by parents of children with non-urgent conditions is an important and unresolved problem, associated with overcrowding, higher costs, lower quality of care and longer waiting times. The majority of research on this topic has taken place in high-income countries with a dearth of work originating in middle and low-income regions. The aim of this study was to explore reasons for parents attending EDs with their child for non-urgent conditions in Turkey. Methodology: This study utilised a qualitative approach. Semi-structured interviews were conducted with thirteen parents in two regions of Turkey between March and May 2017. Data were analysed using principles of grounded theory. Findings: Parents’ perspectives were classified into five core categories: (1) parents’ feelings, knowledge, and ability to provide self-care; (2) perceived needs for care; (3) limitations of healthcare services/system and staff; (4) trust with ED services, greater resources, convenience and access; and (5) experiences with ED services and the consequences of ED overcrowding. Parents expressed how their feelings regarding their children affected their decision-making processes in relation to healthcare services utilisation. Parents reported that they were worried, anxious, and nervous as well as expressing their fears when their child was sick, and how such parental feelings may have influenced them to use the ED. In addition, low health literacy amongst parents, a limited ability to provide self-care and, therefore, being less capable to manage common childhood illnesses affected ED utilisation. Furthermore, parents perceived their child’s condition as urgent and thought that they would need an ED visit. Moreover, greater trust in ED services, greater resources, being more convenient and ease of access had influenced parents in relation to using the ED rather than their GP. Finally, parents expressed their experiences with using the ED and reported how overcrowding in the ED affected ED services, ED staff and patients. These adverse impacts of ED overcrowding included dissatisfaction, staff occupational stress, lack of interest, being unable to treat patients effectively, poor patient outcomes which led parents to revisit the ED or other healthcare services. Conclusion: This is the first Turkish-based study on parents’ reasons for using EDs for their children with non-urgent conditions. The study identified how ED use is a complex and multi-dimensional issue. This study may inform healthcare providers and policymakers to better understand this issue and help to design high impact solutions and interventions to mitigate overcrowding in EDs. Greater effort must be made to reduce unnecessary visits to the ED to meet service user needs, and to increase satisfaction of both parents and healthcare staff.