413 - An Investigation Among Walk-in and Referred Patients in a Pediatric Emergency Department Waiting Room

Publication Number: 4404.413

Shelby K. Shelton, Children's Hospital of Orange County, Orange, CA, United States; Mingfei Dong, CHOC Children's Hospital of Orange County, Los Angeles, CA, United States; Haneen Allahaleh, CHOC Children's Hospital of Orange County, Irvine, CA, United States; Grace Yip, CHOC Children's Hospital of Orange County, Alhambra, CA, United States; Carolina Amaya, CHOC Children's Hospital of Orange County, Austin, TX, United States; Anahita Darabpour, CHOC Children's Hospital of Orange County, 273 Richland rd, CA, United States; Raymond Nguyen, CHOC Children's Hospital of Orange County, Anaheim, CA, United States; Jacqueline Raetz-Vigon, CHOC Children's Hospital of Orange County, Irvine, CA, United States; Catherine Roman-Estrada, CHOC Children's Hospital of Orange County, Carson, CA, United States; Theodore Heyming, CHOC Children's Hospital of Orange County, Orange, CA, United States

Background: Medical care via entry through the Emergency Department (ED) can start as a referral from another medical provider or as patient or caregiver choice. ED use for non-emergency medical issues may burden the hospital system through increased wait times leading to decreased patient satisfaction. Further understanding of the differences between referred and de-novo patient populations could help develop future targeted interventions.

Objective: To identify factors associated with choosing the ED over other levels of care by determining the source of referral, reasons for ED visit, medical access, medical literacy, and anxiety.

Design/Methods: This is a prospective cross-sectional survey of parents/caregivers waiting in a pediatric ED waiting room. Data were collected via distribution of surveys in REDCap to English- or Spanish-speaking parents. Associations were determined using Wilcoxon rank sum test and Pearson’s Chi-square test.

Results: A total of 1,272 participants were enrolled; 33% (n=419) were referred and 67% (n=853) were walk-in. About half (48%) of referred patients were referred by phone call and 34% via in-person clinic visit. There were similar proportions of gender and race in the referred vs. walk-in populations; though more patients of Hispanic ethnicity presented in the walk-in population (74% vs 58%; p< 0.001). The walk-in cohort experienced lower anxiety (p < 0.001) and rated seriousness of illness lower than participants in the referred cohort (p < 0.001), though parents from both cohorts rated their appraisal of child’s illness severity high on a scale of 1-10 (6±2.4). ESI was higher (less acute) in the walk-in cohort (p < 0.001), patients were more frequently admitted to the hospital (p < 0.001), had longer lengths of stay (p < 0.001). There was not a significant difference in health literacy scores between cohorts, though more parents in the walk-in cohort reported high school diploma or lower as their highest attained education (29% vs 19%; p< 0.001, while those in the referred cohort reported college degrees or higher (23% vs 32%; p< 0.001).

Conclusion(s): Referrals to the ED from other clinicians may increase anxiety and perceived severity of illness when compared to walk-in patients. This perception may not be unfounded given the significant admission rates in this population; referrals are admitted at a rate four times greater than walk-ins. There is evidence that patients with the ability to obtain a referral have higher access to formal education; a clear dichotomy exists in the ability to utilize these avenues of entry into the medical system.