Caregiver perceptions and experiences of paediatric emergency department attendance during the COVID-19 pandemic: A mixed-methods study.

BACKGROUND: During the early stages of the COVID-19 pandemic, concerns were raised about reduced attendance at hospitals, particularly in paediatric emergency departments, which could result in preventable poorer outcomes and late presentations among children requiring emergency care. We aimed to investigate the impact of COVID-19 on health-seeking behaviour and decision-making processes of caregivers presenting to paediatric emergency services at a National Health Service (NHS) Trust in London. MATERIALS AND METHODS: We conducted a mixed-methods study (survey and semi-structured interviews) across two hospital sites between November-December 2020. Data from each study were collected concurrently followed by data comparison. RESULTS: Overall, 100 caregivers participated in our study; 80 completed the survey only, two completed the interview only and 18 completed both. Our quantitative study found that almost two-thirds (63%, n = 62) of caregivers attended the department within two days of their child becoming ill. Our qualitative study identified three major themes which were underpinned by concepts of trust, safety and uncertainty and were assessed in relation to the temporal nature of the pandemic and the caregivers' journey to care. We found most caregivers balanced their concerns of COVID-19 and a perceived "overwhelmed" NHS by speaking to trusted sources, predominantly general practitioners (GPs). CONCLUSION: Caregivers have adapted their health-seeking behaviour throughout the pandemic as new information and guidance have been released. We identified several factors affecting decisions to attend; some existed before the pandemic (e.g., concerns for child's health) whilst others were due to the pandemic (e.g., perceived risks of transmission when accessing healthcare services). We recommend trusted medical professionals, particularly GPs, continue to provide reassurance to caregivers to seek emergency paediatric care when required. Communicating the hospital safety procedures and the importance of early intervention to caregivers could additionally provide reassurance to those concerned about the risks of accessing the hospital environment.

Parental perceptions of paediatric emergency departmental attendance in children during the COVID-19 pandemic in UK (PPEDiC). The quantitative outcomes

BackgroundSince March 2020, National lockdowns in UK to control the spread and impact of the COVID-19 pandemic have resulted in a reduction in children attending Paediatric Emergency Departments (PED) nationwide. At our Trust, there was a 46% reduction in PED attendances in 2020 compared to the same two-month period in 2019 (6631 v 12092).ObjectivesThe study aims were to analyse the impact of lockdown on PED attendance in our Trust, identify reasons for reduced attendance, drivers of change in behaviour, the clinical conditions, timing, and outcomes of PED attendees.MethodsThis quantitative sub-study was part of a prospective mixed methods study that recruited caregivers of children ≤16 years attending PEDs in our Trust during November-December 2020. A semi-structured questionnaire was used to collect data including demographics, details on reason for attendance, source and type of advice sought prior to attendance, the form of transport used to get to PED and clinical outcomes of the attendees. Likert scales were used to assess fears and drivers of change in behaviour around PED attendance. We used frequencies, proportions and Spearman’s correlation coefficient to summarize the data. Likert scale data was analysed using measures of central tendency (median) and dispersion (interquartile range).ResultsA total of 98 caregivers who attended PED with their children during the study period were recruited randomly. Most participants were female (79.6%). About 92% of the participants disclosed their ethnicity: with 57/90 (63%) were white, 19(21%) identified as black and 14(16%) were other races including people of Asian and Hispanic descent.Over 60% of participants came to PED within 2 days of illness, with mode of transport being: by ambulance (13%), drove their own cars (59%) and used public transport (13%). The commonest clinical presentation was injuries 29/98 (30%), followed by respiratory conditions 11/98 (11%). A total of 76 (78%) were discharged while 17(17%) were admitted.The main concerns related to PED attendance were;risk of contracting COVID-19(41%);and concerned about overburdening the NHS (25%). Just under half, 42/98 (43%), of participants stated that they would have attended PED in the same time frame as they did in contrast to 32/98 (32.6%) of those who felt they would have attended earlier if there was no pandemic. Whilst 22/98 (22.4%) were not worried about attending PED at all. There was no correlation between self-rated level of worry about coming to PED and time taken to PED attendance (spearman correlation co-efficient = 0.1399)Most participants 60/98(61.2%) discussed their child’s illness with another person prior to presentation. 5/98 (5.1%) of the participants were advised not come to ED but they decided to attend anyway. 28/98 (28.6%) participants contacted GPs followed by 19/98 (19%) who consulted the NHS 111 service.ConclusionsThis study demonstrates that in line with national figures, PED attendances fell dramatically during the Covid pandemic, especially in the area of respiratory illness. For the carers who brought their children to the PED, there was a high level of concern about safety and infection control for themselves and their children that needs to be addressed.