Effects of Social Work Intervention on Nonemergent Pediatric Emergency Department Utilization‪.‬

Clinicians, administrators, and payers agree that the most efficient and cost-effective use of hospital and financial resources is served when emergent care is reserved for people in medical crisis and is confined problems that cannot be managed in primary care settings. Nonemergent cases interfere with the operation of the emergency department (ED), and the cost of such care is excessive (Gadomski, Perkis, Horton, Cross, & Stanton, 1995; Glotzer, Sager, Socolar, & Weitzman, 1991; Hurley, Freund, & Taylor, 1989). Moreover, the ED is not an optimal setting for primary care, and visits to the ED may weaken relationships with primary care providers (Gadomski et al.; Glotzer et al.). Other factors preclude treating children for nonemergent problems in an emergency setting. Each time a child is brought to the ED he or she will likely see a different physician, usually not a pediatrician (Foltin, 1995). The examining doctor typically does not have the child's medical record. The focus is on the immediate need, and the environment does not encourage asking for or providing anticipatory guidance and preventive education or following up on previous visits. There is no opportunity to develop ongoing relationships (Rosenzweig, 1993), and it may be more difficult to diagnose pediatric chronic illnesses or to detect cases of child abuse or neglect.