Clinical Study
Could Pressure to Prescribe Be Contributing to Pediatric Emergency Department Visits?
HealthTrackRx • Mar 23, 2026
An Emerging Tension in Pediatric Urgent Care
Two recently published studies, viewed together, raise an uncomfortable but necessary question for urgent care and pediatric clinicians.
Study #1 – Journal of Urgent Care Medicine (JUCM)
Pressure to prescribe in pediatric urgent care may be contributing to rising pediatric emergency department visits. A survey of 150 pediatric urgent care providers found:
- Over 50 percent reported changing management plans due to parental pressure for antibiotics
- 77 percent reported that this pressure adds meaningful stress to their clinical roles
Source: Journal of Urgent Care Medicine. “Parental Pressure and Antibiotic Prescribing in Pediatric Urgent Care.”
Study #2 – Journal of the Pediatric Infectious Diseases Society (JPIDS)
National surveillance data from 2019 to 2023 demonstrated that antibiotics were implicated in more than one-third of pediatric emergency department visits for adverse drug events. This equates to:
- An estimated 47,628 ED visits annually during 2019 to 2023
- 73,095 visits in 2023 alone
Antibiotics remain one of the most common medication classes leading to pediatric emergency visits.
Source: Journal of the Pediatric Infectious Diseases Society. “US Emergency Department Visits for Antibiotic Adverse Drug Events in Children, 2019–2023.”
When these findings are examined side by side, the question becomes unavoidable:
If clinicians report altering prescribing behavior under pressure, and antibiotics are simultaneously driving tens of thousands of pediatric ED visits annually, is there overlap?
We cannot draw a direct causal line from these studies alone. Many adverse reactions occur even when antibiotics are appropriately prescribed. Period.
However, the signal warrants attention.
Why This Conversation Matters Now
Infectious complaints remain among the top drivers of urgent care utilization. At the same time:
- Patient expectations for speed, certainty, and rapid relief are rising
- There is a persistent mismatch between an illness’s natural history and patient expectations
- Antibiotic and steroid stewardship remain under pressure
- Clinicians report concern about negative reviews and NPS scores
- Competition among nearby urgent care centers may undermine consistency
As Lisa H. Bishop, DNP, MHA, FNP-BC, CDEO, FCUCM, Vice President of the College of Urgent Care Medicine, notes:
“Clinician training must evolve to meet the expectations of empowered patients—who arrive informed, sometimes misinformed, but always with a strong sense of urgency. How we communicate and educate is just as critical as what we diagnose.”
Steven Goldberg, MD, MBA, Chief Medical Officer at HealthTrack, reinforces this operational reality:
“Today’s urgent care patient arrives with the expectation of speed, clarity, and addressing their symptoms. When we can meet those expectations, we earn their trust and enhance outcomes.”
Elizabeth McCarty, MD, Medical Director at Mercy Urgent Care & Occupational Medicine, adds:
“We’re seeing more patients who arrive with expectations for diagnostics and prescriptions. Our job is to balance those expectations with evidence-based care and empathy—especially when ‘no antibiotic today’ is the best prescription.”
What Patients Are Actually Seeking
When families walk into urgent care, antibiotics are rarely the primary objective. Across multiple studies, only about one-third of patients presenting with acute respiratory complaints expect an antibiotic.
Yet clinicians routinely overestimate this expectation.
What patients consistently seek:
- To be heard and taken seriously
- A careful exam
- A plain language explanation of what is happening in the body
- A diagnosis label they understand
- Relief of their most bothersome symptoms
- Clear guidance on what to expect next
- Explicit red flag instructions
Antibiotics and systemic steroids are often perceived as symbols that “something is being done,” not necessarily as the desired endpoint.
If urgent care does not address the primary symptom that prompted the visit, satisfaction drops, regardless of diagnostic accuracy.
The Mismatch: Natural History vs Expectations
Misunderstanding of symptom duration is a major driver of inappropriate prescribing.
Patients routinely underestimate:
- Acute cough duration, often 2 to 3 weeks
- Typical course of viral upper respiratory infections
- Evolution of acute bacterial rhinosinusitis
- Natural progression of uncomplicated UTIs
A common scenario: “I’m traveling tomorrow. I want to knock this out quickly.”
When symptoms exceed the patient’s internal timeline, the patient assumes they are not healing or are in danger. This fuels dissatisfaction and pressure for prescriptions.
Explaining when bacteria are likely to emerge, when antibiotics alter outcomes, and when they do not, resets expectations.
A “prescription” for specific over-the-counter regimens, with dosing and duration guidance, often satisfies the need for action without unnecessary antibiotics.
The Steroid Question
Systemic steroids are frequently prescribed for:
- Acute viral bronchitis
- Uncomplicated URIs
- Sinusitis without clear bacterial criteria
Evidence of benefit in non-asthmatic viral illness is limited. Potential harms include:
- Hyperglycemia
- Mood changes
- Sleep disturbance
- Immunosuppression
- Rare serious adverse events
Concurrent unnecessary antibiotic and steroid prescribing compounds risk without improving outcomes.
Yet steroids are often perceived as a fast solution for cough, congestion, or wheezing.
Education plus structured communication reduces inappropriate steroid use while preserving satisfaction.
Drivers of Overprescribing in Urgent Care
From the clinician’s perspective, pressures include:
- Time constraints in high-volume shifts
- Anticipated conflict
- Fear of negative reviews
- Habitual practice patterns
- Defensive prescribing
- Inexperience and fear of missing a serious diagnosis
Prescribing can feel faster than explaining.
But education plus conversation is a stronger predictor of patient satisfaction than education alone.
The Role of Diagnostics
Diagnostic testing can provide clinical confidence and reduce unnecessary prescribing.
Modality selection should be guided by pretest probability:
- Rapid antigen tests are faster and less expensive but may have lower sensitivity
- Point-of-care molecular testing offers higher sensitivity and may eliminate confirmatory testing
- Next-day molecular results can support a watchful waiting approach
Diagnostics do not replace communication. They support it.
Shared Decision Making: Evidence-Based Strategy
Shared decision making (SDM) has been shown to reduce antibiotic prescribing for acute respiratory infections by approximately 25 to 50 percent without increasing complications or return visits.
Patient satisfaction remains stable or improves when SDM is implemented appropriately.
One practical framework is SHARE:
- S: Seek patient participation
- H: Help compare options
- A: Assess values and preferences
- R: Reach a joint decision
- E: Evaluate the decision
Effective SDM in urgent care includes:
- Asking, “What worries you most about these symptoms?”
- Explaining the diagnosis in plain language
- Outlining expected symptom timelines
- Discussing risks and benefits of antibiotics and steroids
- Providing specific symptom relief guidance
- Creating a clear safety-net plan
Safety-netting is critical. Many parents worry: “What if my child gets worse?” Clear return criteria reduce anxiety and unnecessary ED utilization.
Communication Frameworks That Support Stewardship
Two structured communication models are particularly effective:
AIDET
- Acknowledge
- Introduce
- Duration
- Explanation
- Thank
HEART
- Hear
- Empathize
- Apologize when appropriate
- Respond
- Thank
Consistent use of these tools improves satisfaction, reduces complaints, and allows clinicians to say no to antibiotics or steroids without saying no to the patient.
Language matters. Avoid “It’s just a virus.”
Use positive framing: what you will do, not what you will withhold.
Urgent Care as a Stewardship Checkpoint
Urgent care functions as:
- A substitute for delayed primary care
- A relief and reassurance center
- A gatekeeper for ED utilization
- A critical checkpoint for antibiotic and steroid stewardship
Consistency across clinicians and sites is essential. If one nearby clinic prescribes liberally, stewardship efforts across the region erode.
Accredited urgent care centers are positioned to exceed the outdated “doc in the box” model by embedding evidence-based standards and communication training.
Conclusion: Returning to the Central Question
We cannot prove that parental pressure directly drives pediatric ED visits for antibiotic adverse events.
But we know:
- Clinicians report altering prescribing under pressure
- Antibiotics account for tens of thousands of pediatric ED visits annually
- Many prescriptions are written for self-limiting viral illnesses
- Shared decision making reduces inappropriate prescribing without harming satisfaction
The overlap deserves thoughtful examination.
This is not about blaming parents. Parents are the child’s strongest advocate.
This is about strengthening exam-room communication, aligning expectations with evidence, and designing urgent care visits that prioritize symptom relief, diagnostic clarity, and safety.
Reframing success from “Did I prescribe?” to “Does this family understand and feel confident?” may be one of the most important culture shifts in pediatric urgent care.
Antibiotics remain a high-yield target for preventing adverse events. Communication remains a high-yield target for stewardship improvement.
Both are within our control.
Related Articles and White papers
HealthTrackRx • Mar 23, 2026
An Emerging Tension in Pediatric Urgent Care
Two recently published studies, viewed together, raise an uncomfortable but necessary question for urgent care and pediatric clinicians.
Study #1 – Journal of Urgent Care Medicine (JUCM)
Pressure to prescribe in pediatric urgent care may be contributing to rising pediatric emergency department visits. A survey of 150 pediatric urgent care providers found:
- Over 50 percent reported changing management plans due to parental pressure for antibiotics
- 77 percent reported that this pressure adds meaningful stress to their clinical roles
Source: Journal of Urgent Care Medicine. “Parental Pressure and Antibiotic Prescribing in Pediatric Urgent Care.”
Study #2 – Journal of the Pediatric Infectious Diseases Society (JPIDS)
National surveillance data from 2019 to 2023 demonstrated that antibiotics were implicated in more than one-third of pediatric emergency department visits for adverse drug events. This equates to:
- An estimated 47,628 ED visits annually during 2019 to 2023
- 73,095 visits in 2023 alone
Antibiotics remain one of the most common medication classes leading to pediatric emergency visits.
Source: Journal of the Pediatric Infectious Diseases Society. “US Emergency Department Visits for Antibiotic Adverse Drug Events in Children, 2019–2023.”
When these findings are examined side by side, the question becomes unavoidable:
If clinicians report altering prescribing behavior under pressure, and antibiotics are simultaneously driving tens of thousands of pediatric ED visits annually, is there overlap?
We cannot draw a direct causal line from these studies alone. Many adverse reactions occur even when antibiotics are appropriately prescribed. Period.
However, the signal warrants attention.
Why This Conversation Matters Now
Infectious complaints remain among the top drivers of urgent care utilization. At the same time:
- Patient expectations for speed, certainty, and rapid relief are rising
- There is a persistent mismatch between an illness’s natural history and patient expectations
- Antibiotic and steroid stewardship remain under pressure
- Clinicians report concern about negative reviews and NPS scores
- Competition among nearby urgent care centers may undermine consistency
As Lisa H. Bishop, DNP, MHA, FNP-BC, CDEO, FCUCM, Vice President of the College of Urgent Care Medicine, notes:
“Clinician training must evolve to meet the expectations of empowered patients—who arrive informed, sometimes misinformed, but always with a strong sense of urgency. How we communicate and educate is just as critical as what we diagnose.”
Steven Goldberg, MD, MBA, Chief Medical Officer at HealthTrack, reinforces this operational reality:
“Today’s urgent care patient arrives with the expectation of speed, clarity, and addressing their symptoms. When we can meet those expectations, we earn their trust and enhance outcomes.”
Elizabeth McCarty, MD, Medical Director at Mercy Urgent Care & Occupational Medicine, adds:
“We’re seeing more patients who arrive with expectations for diagnostics and prescriptions. Our job is to balance those expectations with evidence-based care and empathy—especially when ‘no antibiotic today’ is the best prescription.”
What Patients Are Actually Seeking
When families walk into urgent care, antibiotics are rarely the primary objective. Across multiple studies, only about one-third of patients presenting with acute respiratory complaints expect an antibiotic.
Yet clinicians routinely overestimate this expectation.
What patients consistently seek:
- To be heard and taken seriously
- A careful exam
- A plain language explanation of what is happening in the body
- A diagnosis label they understand
- Relief of their most bothersome symptoms
- Clear guidance on what to expect next
- Explicit red flag instructions
Antibiotics and systemic steroids are often perceived as symbols that “something is being done,” not necessarily as the desired endpoint.
If urgent care does not address the primary symptom that prompted the visit, satisfaction drops, regardless of diagnostic accuracy.
The Mismatch: Natural History vs Expectations
Misunderstanding of symptom duration is a major driver of inappropriate prescribing.
Patients routinely underestimate:
- Acute cough duration, often 2 to 3 weeks
- Typical course of viral upper respiratory infections
- Evolution of acute bacterial rhinosinusitis
- Natural progression of uncomplicated UTIs
A common scenario: “I’m traveling tomorrow. I want to knock this out quickly.”
When symptoms exceed the patient’s internal timeline, the patient assumes they are not healing or are in danger. This fuels dissatisfaction and pressure for prescriptions.
Explaining when bacteria are likely to emerge, when antibiotics alter outcomes, and when they do not, resets expectations.
A “prescription” for specific over-the-counter regimens, with dosing and duration guidance, often satisfies the need for action without unnecessary antibiotics.
The Steroid Question
Systemic steroids are frequently prescribed for:
- Acute viral bronchitis
- Uncomplicated URIs
- Sinusitis without clear bacterial criteria
Evidence of benefit in non-asthmatic viral illness is limited. Potential harms include:
- Hyperglycemia
- Mood changes
- Sleep disturbance
- Immunosuppression
- Rare serious adverse events
Concurrent unnecessary antibiotic and steroid prescribing compounds risk without improving outcomes.
Yet steroids are often perceived as a fast solution for cough, congestion, or wheezing.
Education plus structured communication reduces inappropriate steroid use while preserving satisfaction.
Drivers of Overprescribing in Urgent Care
From the clinician’s perspective, pressures include:
- Time constraints in high-volume shifts
- Anticipated conflict
- Fear of negative reviews
- Habitual practice patterns
- Defensive prescribing
- Inexperience and fear of missing a serious diagnosis
Prescribing can feel faster than explaining.
But education plus conversation is a stronger predictor of patient satisfaction than education alone.
The Role of Diagnostics
Diagnostic testing can provide clinical confidence and reduce unnecessary prescribing.
Modality selection should be guided by pretest probability:
- Rapid antigen tests are faster and less expensive but may have lower sensitivity
- Point-of-care molecular testing offers higher sensitivity and may eliminate confirmatory testing
- Next-day molecular results can support a watchful waiting approach
Diagnostics do not replace communication. They support it.
Shared Decision Making: Evidence-Based Strategy
Shared decision making (SDM) has been shown to reduce antibiotic prescribing for acute respiratory infections by approximately 25 to 50 percent without increasing complications or return visits.
Patient satisfaction remains stable or improves when SDM is implemented appropriately.
One practical framework is SHARE:
- S: Seek patient participation
- H: Help compare options
- A: Assess values and preferences
- R: Reach a joint decision
- E: Evaluate the decision
Effective SDM in urgent care includes:
- Asking, “What worries you most about these symptoms?”
- Explaining the diagnosis in plain language
- Outlining expected symptom timelines
- Discussing risks and benefits of antibiotics and steroids
- Providing specific symptom relief guidance
- Creating a clear safety-net plan
Safety-netting is critical. Many parents worry: “What if my child gets worse?” Clear return criteria reduce anxiety and unnecessary ED utilization.
Communication Frameworks That Support Stewardship
Two structured communication models are particularly effective:
AIDET
- Acknowledge
- Introduce
- Duration
- Explanation
- Thank
HEART
- Hear
- Empathize
- Apologize when appropriate
- Respond
- Thank
Consistent use of these tools improves satisfaction, reduces complaints, and allows clinicians to say no to antibiotics or steroids without saying no to the patient.
Language matters. Avoid “It’s just a virus.”
Use positive framing: what you will do, not what you will withhold.
Urgent Care as a Stewardship Checkpoint
Urgent care functions as:
- A substitute for delayed primary care
- A relief and reassurance center
- A gatekeeper for ED utilization
- A critical checkpoint for antibiotic and steroid stewardship
Consistency across clinicians and sites is essential. If one nearby clinic prescribes liberally, stewardship efforts across the region erode.
Accredited urgent care centers are positioned to exceed the outdated “doc in the box” model by embedding evidence-based standards and communication training.
Conclusion: Returning to the Central Question
We cannot prove that parental pressure directly drives pediatric ED visits for antibiotic adverse events.
But we know:
- Clinicians report altering prescribing under pressure
- Antibiotics account for tens of thousands of pediatric ED visits annually
- Many prescriptions are written for self-limiting viral illnesses
- Shared decision making reduces inappropriate prescribing without harming satisfaction
The overlap deserves thoughtful examination.
This is not about blaming parents. Parents are the child’s strongest advocate.
This is about strengthening exam-room communication, aligning expectations with evidence, and designing urgent care visits that prioritize symptom relief, diagnostic clarity, and safety.
Reframing success from “Did I prescribe?” to “Does this family understand and feel confident?” may be one of the most important culture shifts in pediatric urgent care.
Antibiotics remain a high-yield target for preventing adverse events. Communication remains a high-yield target for stewardship improvement.
Both are within our control.
Related Articles and White papers
