"Family plan"--multiple-patient visits from the same family to an inner-city pediatric emergency department

Abstract

Objectives: The issue of multiple family members presenting to the emergency department (ED) for care during a single visit is unique to pediatric EDs (PEDs). The epidemiology of such multiple-patient visits (MPVs) has not been well characterized. The aims of this study were to describe patient characteristics, Emergency Severity Index (ESI) triage categories, length of stay, ED disposition, and payer characteristics of such MPV and to compare these characteristics to that of the overall ED visits (OEVs).

Methods: We conducted a retrospective chart review of MPVs to an inner-city PED from June to December 2006. We collected patient demographics, ESI triage categories, ED disposition, length of stay, and payer characteristics. Descriptive methods and comparative methods were used to summarize the sample characteristics and compare group differences, respectively.

Results: Multiple-patient visit constituted 2.2% (1166/52,491) of the total ED visits with a total of 2511 patients. The majority (88%; 1025/1166) of such visits were with 2 patients in a family. Ninety-one percent (2285/2511) of patients presented for medical complaints. Compared with the OEV, MPV belonged significantly more to ESI triage category 5 (51.2% vs 28.6%) and less to ESI triage category 3 (10.0% vs 24.6%; χ(2) = 775.4; P < 0.01). A significantly higher percentage of MPV patients belonged to Medicaid Health Maintenance Organization compared with the OEV patients (72.4% vs 47.6%; P < 0.01). Only 3.3% of MPV patients required hospital admission.

Conclusions: In our inner-city PED, most of the MPVs are for medical complaints, belong to a lower acuity, and have a low hospital admission rate.