Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital

Miyazawa, Asako; Maeno, Takami; Shaku, Fumio; Tsutsumi, Madoka; Kojima, Hiroshi; Takayashiki, Ayumi; Kohno, Mototsugu; Suzuki, Michitaka; Maeno, Tetsuhiro

doi:10.1002/jgf2.249

Cited by 16 publications

(21 citation statements)

References 21 publications

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“…Inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. Studies evaluating this phenomenon have found that the inability to take time off from school or work during the day and the ease of use of emergency care without the need for an appointment are cited as a reason for their consultation by a significant percentage of patients, suggesting that inappropriate use of ED could be a matter of personal convenience [14,15]. An observational study investigated the factors associated with ED visits for headache and found that the most common reason for visiting ED was a perceived emergency condition or referral by a physician (33.3%) [16].…”

Section: Introductionmentioning

confidence: 99%

Rapid referral for headache management from emergency department to headache centre: four years data

et al. 2020

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Background Headache is one of the most common reason for medical consultation to emergency department (ED). The inappropriate use of ED for non-emergency conditions is a problem in terms of overcrowding of emergency facilities, unnecessary testing and treatment, increased medical costs, burden on medical service providers and weaker relationships between patient and primary care provider. The aim of this study was to analyze the different stages of ED management of headache to identify those deficiencies that can be overcome by a fast referral to a headache clinic. Methods The study is a retrospective analysis of the electronic medical records of patients discharged from an academic ED between January 1, 2015 and December 31, 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all aspects related to the permanence in ED and also assessed whether there was a match between the diagnosis made in ED and ours. Results Among our sample of 244 patients, 76.2% were admitted as “green tag”, 75% underwent a head computed tomography, 19.3% received a neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. The length of stay in ED was associated with reporting the first aura ever (p = 0.014) and whether patients received consultations (p < 0.001). The concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre. Conclusions Most patients who went to ED complaining of headache received the same treatment regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the many shortcomings in headache management in ED, rapid referral to the headache centre is of paramount importance to help the patient achieve a definiteve diagnosis and appropriate treatment.

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Section: Introductionmentioning

confidence: 99%

Rapid referral for headache management from emergency department to headache centre: four years data

et al. 2020

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“…Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. Studies evaluating this phenomenon found that inability to take time off from school or work during the day, the ease of use of emergency care and the non-necessity for an appointment are indicated as a reason for their consultation by a significant percentage of patients, suggesting that inappropriate use of ED could be a matter of personal convenience [13,14]. An observational study investigated the factors associated with ED visits for migraine and found that the most common reason for visiting ED was a perceived emergency condition or referral by a physician (33.3%) [15].…”

Section: Introductionmentioning

confidence: 99%

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Negro

Spuntarelli

Sciattella

et al. 2020

Preprint

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Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.

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“…Finally, some factors associated with inappropriate ED usage were not studied. A recent study in a Japanese hospital found that having two or more prior out-of-hours ED visits in the past 3 years was identified as a factor [14].…”

Section: Discussionmentioning

confidence: 99%

“…These visits are all the more “inappropriate” because the majority of them occur during the business hours of most primary care providers (PCP) [10], for the most part at the sole initiative of the patient [1,2,11,12,13]. Personal convenience and ease of emergency care use were listed as motivations for consulting ED in several countries, such as Japan [14], the United States [15], and Spain [16]. This influx of non-severe patients does not benefit from the holistic management that a general practice provides and it increases the already growing number of ED consultations caused by an aging population and a rise in chronic illnesses [17].…”

Section: Introductionmentioning

confidence: 99%

Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care

Ghazali

Richard²,

Chaudet

et al. 2019

IJERPH

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Consultations that do not require an emergency department (ED) level of care have increased. We explored attitudes of non-urgent patients in two academic hospitals in France with a similar fast track organization. One of them is a Parisian hospital with 90,000 patients/year who are admitted to the ED, while the other admits 40,000 patients/year in a smaller city. During one month in 2018, the triage nurse handed out a survey to patients coming for non-urgent consultations. It was given back to the fast track physician at the end of the visit; 598 patients agreed to answer. They were mostly young males with adequate social coverage, consulting for osteo-articular pathologies, without any significant difference between the two sites (p = 0.32). They were equally satisfied with the care they received (p = 0.38). Satisfaction was inversely correlated to waiting time (p < 0.0001). Convenience, accessibility of emergency facilities, and geographic proximity were motivation factors. These results suggest that primary care providers who can access testing facilities in accordance with patient needs might be a solution to help reduce overcrowding in EDs.

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Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital

Cited by 16 publications

References 21 publications

Rapid referral for headache management from emergency department to headache centre: four years data

Rapid referral for headache management from emergency department to headache centre: four years data

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care

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