Emergency department crowding: why do patients walk-in?

Abstract

Objectives: For years, general practitioners (GP) shortage and patients' increasing demand for acute care have been associated with Emergency Department (ED) crowding. Indeed, EDs admissions for non-emergency care seem to constantly increase. Surprisingly, the rationale for patients own decision to directly reach EDs over primary care have been poorly investigated to date. Methods: We conducted a study on patients admitted in two University EDs during nine consecutive days. Patients were asked to answer a survey about their frames for coming and if they were self-referred, referred by a GP, a specialist or after calling the Emergency Number. Results: During the study period, 68.0% of patients were self-referred, 17.0% referred by their GP, 8.5% by a specialist and 7% after an emergency call. 51.0% of the self-referrals thought EDs were the appropriate location to deal with their health problem and 24.0% because of a better accessibility. We noticed that 15.0% of the incomings looked for specialized care and 4.22% reported that the stress had motivated them. Of note, 4.6% of the patients were attracted by the hospital reputation. Financial concerns represented less than 1.0% of the motives invocated. Conclusion: We found that patients' self-perceived severity of illness is the predominant frame to each the ED when they face needs for acute care. EDs' accessibility as compared with other facilities also seems to encourage patients to come to the ED. Other factors such as the hospital reputation or patients' stress tend to influence ED attendance but to a much lesser extent.

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

“…Although patients considered visiting the ED for particular problems, they declared to have enough con dence in the skills and competences of the GP. The link between these type of problems (wounds, musculoskeletal problems) and emergency care is rather the result of an image problem than of a rational believe that GP's are unable to deal with minor traumas (5,22,(26)(27)(28). Younger patients, patients who adhered less to the common principle of self-referring or patients who relied upon the advice of an operator were more likely to be in favour of a co-location.…”

“…Waiting times for unplanned care are a major concern in most health care systems (16). Self-referring patients, understa ng and infrastructural restrictions are the main cause of this problem (5,8,16). Patients in our study were prepared to accept a referral for unplanned care if a trained telephone operator performed the triage.…”

“…Second point of attention is the patient who expects to be directly in contact with a physician when seeking unplanned care. These patients are less likely to follow the advice of an operator and will probably present to their preferred level of care, which in reality will mean that they will sign in to the ED (5,6,23). This action will slow down the time to intervention for the index patient but also for correctly referred patients by interfering with the regular work ow.…”

“…Inappropriate use of the emergency department (ED) is de ned as a use for nonurgent conditions or conditions that can be handled by a general practitioner (GP) (3,4). As compared to other countries, the number of these patient visits is very high in Belgium (5). Patients have free access to the ED where they expect to receive a fast, e cient and sophisticated service (6,7).…”

The implementation of the nationwide out of hours phone number 1733. Analysis of efficiency and safety.

“…In Belgium, there is an increasing problem with the improper use of emergency services (1,2). A study of the 'Federal Knowledge Centre for Healthcare' demonstrated that there is a need for a clear concept of an 'improper out of hours care use' and for the development of an effective triage system: a triage system to send the right patient at the right time to the right health care provider (3).…”