Caretakers' perspectives on return pediatric emergency department visits a qualitative analysis of focus groups

Objectives: Approximately 5% of pediatric patients return to the emergency department (ED) within 72 hours of initial evaluation. The goal of this study was to identify reasons for return visits from the caretaker perspective. Methods: Two parent focus groups were conducted in November 2012. Parents were excluded from participation if the return visit was unrelated to the initial visit or the child was asked to return (e.g., wound check). The focus groups were audiotaped, transcribed, and analyzed using a thematic content analysis approach. Results: A total of 13 parents participated. Children were 10 months to 11 years of age (median, 3.1 years). Primary symptoms and diagnoseswere related to respiratory (n = 6); gastrointestinal (n = 2); dermatologic (n = 2); musculoskeletal (n = 2); and ear, nose, throat and mouth diseases (n = 1). Return visits occurred 12 to 50 hours (median, 24 hours) after the initial visit. Reasons for return visits were divided into 4 domains: (1) the caretaker's response to the initial visit (e.g., dissatisfaction with medical staff, medical care, or information provided), (2) the child's illness (e.g., continued, worsening, or concerning symptoms), (3) the nature of the ED itself (e.g., subspecialist availability, convenient hours), and (4) follow-up care (e.g., lack of appointments with primary physicians or subspecialists). Conclusions: Several of the reasons parents identify for return visits are within the locus of control of the ED, and several could be addressed by improving regional health care coordination. Surveys based on these themes will quantitate the reasons for return visits and prioritize future strategies to address the perceived need for return visits.