Non-Urgent and Non-Referred Patients Presenting to the Emergency Department (ED): Understanding the Reasons of the Non Urgent Patients to Visit the ED

Abstract

Objectives: The objectives of this study are: 1) To understand the reasons of non-urgent non-referred patients to use the Emergency Department (ED), 2) To understand the “urgency” and “concern” perceptions of non-urgent non-referring patients. 3) To determinate the associated factors with the use the ED for non-urgent non-referred patients. Methods: Design: Descriptive cross-sectional study. Setting: Emergency Department (ED) of “Infanta Cristina” General Hospital, Parla, Madrid, Spain. Patients: non-referred non-urgent adult patients were selected by Emergency Department Triage system in levels IV and V, on weekdays between 10:00 and 22:00 hours, from April 26 to July 30, 2010, to be surveyed using a structured face-to-face interview. Main outcome measures: sociodemographic characteristics, personal experience with the health care centre (HCC) and ED, urgency and concern of symptoms, previous health care use regarding current health problem, reasons to visit the ED, comparative evaluation of ED and HCC. Results: 73% of the patients came directly to the ED. More efficient technical services (42%), the HCC was closed in this time (35%), promptly resolution of the health problem (22%) and more accessibility (20%) were the most important reasons to come directly to ED. 27% of the patients went previously to the HCC and then they came to the ED because they did not get better with the treatment prescribed (71%) and they went to know a second opinion (39%). 70% of the patients considered that their health problem was not serious but they thought this situation had to be resolved promptly. 63% of the patients were very worried for their health problem and the same proportion considered that their family doctor could not resolve this problem. Finally, 50% considered that the ED had more technical capacity to resolve their health problem. conclusions: High efficacy and effectiveness, in terms of technical resources and promptness, were the main reasons of non-referred non-urgent adult patients to use the ED. The high preoccupation, but not the perception of seriousness perception, of the health problem was the most important factor to seek care in an active and quickly way. The previous institutional experience in HCC could influence those reasons.