UC Merced

Emergency Departments (ED) originated to support people who were involved in traumas or needed emergent care in order to live. However, over the years and especially since the passing of the Emergency Medical Treatment and Labor Act, the ED has been used more frequently for non-urgent reasons. Non-urgent use increases the cost of care, decreases the patient-provider relationship, and interrupts health care maintenance and promotion. Some of the causes of these visits include convenience, trust, and referrals from primary care providers. The largest utilizers tend to be from both ends of the age spectrum; those greater than 75 and infants. No research found has compared infant ED release utilization to ED and direct admits. Therefore, a mixed methods research study was conducted to: 1. Examine infant, maternal and environmental predictors of ED release utilization versus ED and direct admits; 2. Examine whether the social determinants of health (SDoH) influence when and why infant ED visits versus direct admits occur and; 3. Understand how mothers make decisions about care when their infant is ill. The first and second were completed analyzing California Office of Statewide Health Planning and Development hospital data, while the third analyzed narratives obtained from fifteen interviews with mothers of children 12 months of age or less. Many more infant than maternal factors were associated with hospital use within the first year of life. The predictors of ED release visits and direct admits were inversely related to one another. And, as with previous ED studies, this study found a large percentage (~75%) of infant hospital visits were ED release visits. The SDoH did influence the age, day of week and diagnosis at visit. In addition, regardless of the SDoH, the top five diagnoses for a visit were almost identical. These were upper respiratory infection, fever, otitis media, vomiting alone, and acute bronchiolitis. Results from the qualitative portion of the study identified that the decision pathway for mothers who chose to visit the ED and those who did not was similar, with crucial points influencing the final decision. This information will assist health care providers with developing interventions to reduce non-urgent ED visits.