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

Abstract

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.

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

“…When patients use unplanned care services they are mainly concerned about waiting times, adequacy of referral and competences of the attending physician (and medical staff) (6,8,15). Waiting times for unplanned care are a major concern in most health care systems (16).…”

“…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.…”

“…A third group that needs particular attention are the older patients being less prepared to accept a referral to a co-location service. This might not surprise as they are used to the current system (6,25,26).…”

“…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). Besides, patients are more familiar with this type of out of hours or unplanned care than with the service offered by the GPC's or GP's on duty (7,8).…”

The implementation of the nationwide out-of-hours phone number 1733 in Belgium: analysis of efficiency and safety

“…In international literature, there is a lack of research on the implementation of a central, nationwide number for unplanned out-of-hours care. Since many health care systems are confronted with inefficient patient flows in unplanned or emergency care, an implementation research on this topic might contribute to improvement of this particular type of care (Ghazali et al, 2019;Young et al, 1996).…”