Physician and Parental Decision-Making Prior to Acute Medical Paediatric Admission.

BACKGROUND: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission.

METHODS: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians).

RESULTS: Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described "erring on the side of caution" when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, "erring on the side of caution" was also identified as was managing "parental anxiety" and acting on "gut instinct". Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service.

CONCLUSIONS: The study of parent and referring clinician decision-making prior to a hospital admission can identify "teachable moments" where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as "parental anxiety".