When the visit to the emergency department is medically nonurgent: Provider ideologies and patient advice

It is estimated that more than half of pediatric hospital emergency departm ent (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such vis its are scarce. This study explored the perspectives of 26 providers workin g in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three p rovider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication stra tegies that providers employed with ED users: restrictive, pragmatic, and a ll-inclusive. The analysis resulted in the development of a typology of pro vider ideological orientations toward ED use, distinguished according to di fferent orientations toward professional dominance.