Rural emergency department use by CTAS IV and V patients

Abstract

Objective: For a variety of reasons, many emergency department (ED) visits are classified as less-or nonurgent (Canadian Triage and Acuity Scale [CTAS] level IV and V). A recent survey in a tertiary care ED identified some of these reasons. The purpose of our study was to determine if these same reasons applied to patients presenting with problems triaged at a similar level at a lowvolume rural ED. Methods: A 9-question survey tool was administered to 141 CTAS level IV and V patients who attended the South Huron Hospital ED, in Exeter, Ontario, over a 2-week period in December 2006. Results: Of the 141 eligible patients, 137 (97.2%) completed the study. One hundred and twentytwo patients (89.1%) reported having a family physician (FP) and 53 (38.7%) had already seen an FP before presenting to the ED. Just over one-half of all patients (51.1%) had their problem for more than 48 hours, and 42 (30.7%) stated that they were referred to the ED for care. Fifty-three (38.7%) of the respondents felt they needed treatment as soon as possible. Many patients reported coming to the ED because: 1) their FP office was closed (21.9%); 2) they could not get a timely appointment (16.8%); or 3) the walk-in clinic was closed (24.8%). Only 6 patients (4.4%) specifically stated that they came to the ED because they had no FP. One-third of patients attended the ED because they believed it offered specialized services. Conclusion: In this rural setting, most less-or nonurgent ED patients had an FP yet they went to the ED because they did not have access to primary care, because they perceived their problem to be urgent or because they were referred for or sought specific services. RÉSUMÉ Objectif : Pour de nombreuses raisons, bon nombre des patients se présentant à l'urgence sont classés dans les catégories « moins urgent » ou « non urgent » correspondant respectivement aux niveaux IV et V de l'Échelle canadienne de triage et de gravité (ÉTG). Un récent sondage réalisé à l'urgence d'un centre hospitalier de soins de troisième ligne a mis en lumière certaines raisons. L'objectif de notre étude était de déterminer si les mêmes raisons s'appliqueraient au triage à un niveau semblable chez les patients se présentant à l'urgence dans un centre hospitalier à faible achalandage en milieu rural.

A Population-based Study of the Association Between Socioeconomic Status and Emergency Department Utilization in Ontario, Canada

“…We hypothesized that in Ontario, where a shortage of primary care physicians is recognized across the province, less urgent presentations to the ED could be a reflection of immediate access barriers to alternative sites of care such as family doctors or walk‐in clinics 14,24,25 . This hypothesis is supported by single‐site surveys from Canada that have demonstrated that while less urgent ED use is not associated with lack of a family doctor, it is associated with an inability to access timely primary care 26,27 . A Canadian population‐based study demonstrated that recent primary care reform efforts in Ontario have led to increased rostering of individuals of higher SES than expected for the population, also suggesting reduced primary care access for those with lower SES 28 .…”

Patients’ pathway to emergency care

“…Several studies investigating nonurgent patients' reasons for ED visits underscore other reasons for seeking ED care [10,11,19]. These studies found that it was common for nonurgent patients to seek ED care because they believed they were suffering from a serious condition or that they were worried about their symptoms or they were referred to the ED.…”

“…Previous studies have analysed this phenomenon and investigated what events bring patients to the ED. These suggestions have, however, not been supported by a number of studies [5,[10][11][12]. These suggestions have, however, not been supported by a number of studies [5,[10][11][12].…”

“…These suggestions have, however, not been supported by a number of studies [5,[10][11][12]. The availability of the ED with access to care round the clock has also been suggested as a possible explanation to the increasing ED demand [10,11]. The availability of the ED with access to care round the clock has also been suggested as a possible explanation to the increasing ED demand [10,11].…”

“…It has been suggested that the increased attendance of patients at the ED has been due to a lack of primary care physicians [7][8][9]. Instead, several studies indicate that patients come to the ED in the belief that they have a need for knowledge, investigation or treatment that they think cannot be provided elsewhere [5,10,11,13]. Instead, several studies indicate that patients come to the ED in the belief that they have a need for knowledge, investigation or treatment that they think cannot be provided elsewhere [5,10,11,13].…”