A qualitative systematic review of the reasons for parental attendance at the Emergency Department with children presenting with minor illness

Introduction: Over 5 million children attend the Emergency Department (ED) annually in England with an ever-increasing paediatric emergency caseload echoed globally (HES 14/15). Approximately 60% of children present with illness and the majority have non-urgent illness creating significant pressures on children’s ED and this crisis resonates nationally and globally (Amiel et al., 2014). An urgent need exists to reduce the number of self-referred children attending ED with non-urgent medical complaints. To date no qualitative systematic review exists that focuses on the parental reasons for childhood attendance at the ED in this group.
Method: A qualitative systematic review was conducted against inclusion/exclusion criteria. Five electronic databases plus key journals and conference proceedings were searched in June 2015. Quality assessment was conducted using the JBI-QARI tool prior to a thematic meta- synthesis.
Findings: 471 studies were identified from data sources. Following study selection processes, 4 qualitative studies were identified from the USA and UK. Fifty-six participant quotations were extracted and coded thematically. Nine main themes were identified e.g. dissatisfaction with the family medical service, perceived advantages of ED, ‘child suffering’ amongst others together with novel and insightful sub-themes of ‘hereditary anxiety’, ‘taking it off our hands’, ED as a ‘magical place’.
Discussion: The findings illuminate the range of determinants underpinning childhood ED attendance for minor non-urgent illness. Novel areas not previously seen in the literature were identified. Decision-making analyses may be the way forward to study how parents juggle the aforementioned factors reapplying psychological theories of decision making to the problem of rising child ED attendance rates.
Conclusion: This is the first known qualitative systematic review examining parental attendance in this area, which is of interest to emergency care reformers and clinical staff. ED attendance is complex and multifactorial but parents provide vital insight on their own reasons for ED attendance.