Factors associated with inappropriate use of emergency departments: findings from a cross-sectional national study in France

Abstract

BackgroundInappropriate visits to emergency departments (EDs) could represent from 20% to 40% of all visits. Inappropriate use is a burden on healthcare costs and increases the risk of ED overcrowding. The aim of this study was to explore socioeconomic and geographical determinants of inappropriate ED use in France.MethodThe French Emergency Survey was a nationwide cross-sectional survey conducted on June 11 2013, simultaneously in all EDs in France and covered characteristics of patients, EDs and counties. The survey included 48 711 patient questionnaires and 734 ED questionnaires. We focused on adult patients (≥15 years old). The appropriateness of the ED visit was assessed by three measures: caring physician appreciation of appropriateness (numeric scale), caring physician appreciation of whether or not the patient could have been managed by a general practitioner and ED resource utilisation. Descriptive statistics and multilevel logistic regression were used to examine determinants of inappropriate ED use, estimating adjusted ORs and 95% CIs.ResultsAmong the 29 407 patients in our sample, depending on the measuring method, 13.5% to 27.4% ED visits were considered inappropriate. Regardless of the measure method used, likelihood of inappropriate use decreased with older age and distance from home to the ED >10 km. Not having a private supplementary health insurance, having universal supplementary health coverage and symptoms being several days old increased the likelihood of inappropriate use. Likelihood of inappropriate use was not associated with county medical density.ConclusionInappropriate ED use appeared associated with socioeconomic vulnerability (such as not having supplementary health coverage or having universal coverage) but not with geographical characteristics. It makes us question the appropriateness of the concept of inappropriate ED use as it does not consider the distress experienced by the patient, and segments of society seem to have few other choices to access healthcare than the ED.

Non-COVID Diseases during the Pandemic: Where Have All Other Emergencies Gone?

“…Moreover, it is very common to observe in our hospital, during the first months of the year, ED overcrowding, partially due to the winter virus season and, in part, to inappropriateness of access for non-urgent visits [ 13 , 14 ]. On this subject, some authors suggested that around 20–30% of ED visits may be defined as inappropriate, probably due to some critical issues inside national health systems, such as lack of primary care centers and low collaboration with general practitioners (GPs) [ 15 ].…”

What do emergency department physicians and nurses feel? A qualitative study of emotions, triggers, regulation strategies, and effects on patient care

“…While providers voiced frustrations with certain types of ED visits, which some have described as inappropriate,33 34 providers were also aware of reasons underlying some of these visits. Socioeconomic vulnerabilities, barriers to outpatient care, and limited community-based services lead many to the ED for services that the ED is ill-equipped to provide (eg, psychiatric or substance use services) or not designed to provide (eg, food or shelter), or for services that are arguably unnecessary and expensive for the ED to provide (eg, treatment for seasonal colds) 33 34…”

End-of-Life Admission to the Emergency Department: Experience of Mexico’s National Cancer Institute of a Developing Country

“…14 Disease-related anxiety, feelings of safety, and familiarity with the hospital setting are also factors influencing the patients and their family’s decision to seek urgent medical help at the EOL. 15,16 The integration of PC has been reported to make avoidable ED visits; in this work, only 8.4% of patients had been referred to PC; nevertheless, no statistically significant differences were found in the number of visits to ED in the last month of life.…”