Fear, vulnerability and sacrifice: Drivers of emergency department use and implications for policy

From Their Perspective: The Connection between Life Stressors and Health Care Service Use Patterns of Homeless Frequent Users of the Emergency Department

“…Furthermore, this study is one of only a handful of recent studies that relied on interviews with frequent ED user populations to understand care needs (Capp et al, 2016;Mautner et al, 2013;Poremski et al, 2016). Other previous studies that included both frequent and nonfrequent ED users have highlighted some factors associated with ED use that our study findings support, including fear and uncertainty about symptoms and difficulty accessing outpatient care (Hudgins & Rising, 2016;Rising et al, 2015). Another study highlighted the similarity of self-reported motives for ED visits between frequent and nonfrequent ED users; these findings are also in line with findings from the present study, including access, convenience, cost, quality, and perceived need for urgent care (Doran, Colucci, et al, 2014).…”

“…Another study highlighted the similarity of self-reported motives for ED visits between frequent and nonfrequent ED users; these findings are also in line with findings from the present study, including access, convenience, cost, quality, and perceived need for urgent care (Doran, Colucci, et al, 2014). Previously identified interventions to decrease ED use and increase use of outpatient care have included a focus on structural solutions such as insurance coverage and use of community health workers (Hudgins & Rising, 2016), increasing use of formal medical training models for providers to improve screening and understanding of appropriate variations in care and hospital admission decisions for homeless patients (Doran, Curry, et al, 2014;Salhi et al, 2017). Our findings add the perspective of frequent users who are also homeless, a particularly vulnerable patient population with intersecting challenges that make treatment and engagement in services particularly difficult.…”

Risk Factors Associated with Emergency Department Recidivism in the Older Adult

“…While clinicians feel safe discharging a patient with negative test results, believing that testing did not reveal any cause for emergent treatment or admission, this news may produce the opposite effect in patients due to this diagnostic uncertainty and fear of the unknown cause of their complaints. This lack of diagnostic certainty may lead patients to return to the ED in the hope of finding an answer or out of fear if the symptoms return 20–22. The psychological component experienced by patients during their ED encounters is often overlooked and is a potential area of focus for study and improvement.…”

Identifying Emergency Department Symptom-Based Diagnoses with the Unified Medical Language System

“…1 Studies exploring reasons for return ED visits have identified high levels of patient uncertainty related to lack of a definitive diagnosis as one cause for return. [2][3][4] These findings suggest the…”