PED ED

Why do parents choose to come to the PED?

There are five main reasons why parents attend PED non-urgently.

1. Parental worry. Behavioural science tells us that parents' emotional state will influence their decision-making. If they are worried, they may overestimate the severity of their child’s condition and feel less in control. The ‘Think Sepsis’ campaign aims to reduce mortality and morbidity of childhood sepsis. However, it has the unintended consequence of increasing parental anxiety about minor childhood illness.
2. Perceived advantages of the ED. The ED, where parents experience a more elaborate health encounter compared with other settings (such as the use of pulse oximetry, blood tests and immediate medication) lends ‘confirmation bias’, in which parents will believe that they were right to judge the illness as severe. Any good patient encounter in the PED reinforces that positive perception. The ’messenger effect' suggests that patients are more likely to trust advice that comes from an authoritative source. While this gives us an explanation for the phenomenon of high PED usage, it also indicates potential solutions: the ‘messenger effect’ could be put to good use across the health system, for example, by implementing interventions that reinforce the GP practice as the ‘trusted place’ to be.
3. Perception of other healthcare services. Patients are often unaware of or do not trust alternative services such as pharmacies or out-of-hours GPs in their locality. Patients who need to make a quick decision will choose an obvious ‘brand’ such as the PED—so-called default bias. We may be able to shift those beliefs using behavioural insights which support a high-quality rebranding of such services.
4. Social network influence. Parents often make decisions based on what they have heard from those around them. They also make decisions based on how others may react—they want to be seen to be ’good parents'. This influence can be harnessed by healthcare systems and put to good use: peer-to-peer interaction is being used to promote healthy lifestyles and management of long-term conditions. It can also be used to influence parents’ choices around minor and non-urgent illness.
5. Lack of confidence and low health literacy. We know that educational interventions which enhance health literacy can reduce healthcare demand. Holden’s data indicate that parents lack confidence in assessing the severity of their child’s illness and in choosing the best way to access help. Consultations in the ED rarely include written guidance on what to do next time; even verbal guidance tends to fall away when the ED gets busy. Parents in the ED may not be in an emotional state to be effective learners. ED professionals may not excel as teachers, and time and complexity challenge the feasibility of their teaching in the ED.