Self-referred walk-in patients in the emergency department – who and why? Consultation determinants in a multicenter study of respiratory patients in Berlin, Germany

Abstract

Background Emergency department (ED) consultations are on the rise, and frequently consultations by non-urgent patients have been held accountable. Self-referred walk-in (SRW) consulters supposedly represent a predominantly less urgent patient population. The EMACROSS study aimed to explore consultation determinants and motives in SRW patients with respiratory symptoms. Methods Multicenter survey of adult ED patients with respiratory complaints in eight emergency departments in central Berlin, Germany. Secondary hospital records data including diagnoses was additionally assessed. Characteristics of SRW and non-SRW patients were compared. Determinants of SRW consultation were evaluated by binary logistic regression. Consultation motives were analyzed descriptively. As a supplemental approach, network analysis (lasso-regularized mixed graphical model) was performed to explore connections between consultation determinants, consultation features and motives. Results Between June 2017 and November 2018, n = 472 participants were included, the median age was 55 years (range 18–96), 53.2% of patients were male and n = 185 cases (39.2%) were SRW consulters. The SRW group showed lower proportions of potentially severe (pneumonia and respiratory failure, p < 0.001, χ2 test) and chronic pulmonary conditions. Determinants of SRW consultation identified by logistic regression were younger age (p < 0.001), tertiary education (p = 0.032), being a first-generation migrant (p = 0.002) or tourist (p = 0.008), having no regular primary care provider (p = 0.036) and no chronic pulmonary illness (p = 0.017). The area under the curve (AUC) for the model was 0.79. Personal distress and access problems in ambulatory care were stated most frequently as consultation motives in the SRW group; network analysis showed the scarcity of associations between demographic and medical SRW determinants and motives triggering the actual decision to consult. Conclusions As to “who” consults, this study identified demographic and medical predictors of SRW utilization. The said markers seem only remotely connected to “why” people decide for SRW visits. To alleviate ED crowding by addressing frequent SRW consultation motives, interventions focused on the ability for symptom self-assessment and at better-accessible alternative care seem sensible. Trial registration German Clinical Trials Register (DRKS00011930); date: 2017/04/25.

Self-reported health and life satisfaction in older emergency department patients: sociodemographic, disease-related and care-specific associated factors

“…Furthermore, age was not significantly associated with self-reported health, which is in line with an overall inconsistent state of research on this association [ 39 ]. Female sex was associated with better self-reported health in our sample which is in contrast with past research reporting significantly lower self-reported health in women than in men irrespective of age [ 41 ]. However, a recent review found that the evidence on this association in older adults is inconsistent [ 42 ].…”

Diverting less urgent utilizers of emergency medical services to primary care: is it feasible? Patient and morbidity characteristics from a cross-sectional multicenter study of self-referring respiratory emergency department consulters

“…Setting, design and data collection of EMACROSS, subproject of EMANet (Emergency and Acute Medicine Network for Health Care Research) [ 11 ], have been described previously [ 10 ]. We collected primary (patient survey) and secondary (hospital records) data on respiratory ED consultations, complemented by qualitative patient and provider interviews.…”

“…Patients > 18 years were eligible if able to give written informed consent and proficient in one of the study languages. Participants were recruited between 1st of June 2017 and 30th of November 2018 and surveyed at ED presentation prior to being seen, or between investigations, with a tablet-based questionnaire comprising demographic and medical characteristics, consultation motives and health care utilization (see supplement to [ 10 ]). We also refer to this previous publication for details on operationalization of consultation motives, which were assessed as multi-response data and appropriated to thematic groups (distress, access, quality, and convenience).…”

“…For allocation of self-referral status, we used available data from both survey and hospital records; EMS utilization was determined from ED documentation. For details on data preparation, see [ 10 ]. Demographics, morbidity characteristics, and motives of EMS vs. non-EMS patients were summarized descriptively, and group comparisons were performed by χ 2 test for categorical and Mann–Whitney-U-test for continuous variables.…”

“…Such are a good model to study ED utilization and interactions with PC, constituting frequent consultation triggers in both settings [ 8 , 9 ] and comprising a wide causal spectrum, from medically banal to serious. Cross-sectional data from EMACROSS showed lesser acute and chronic morbidity in self-referred walk-in ED patients [ 10 ]. In extension of this preceding publication, the present paper provides an in-depth look at self-referred EMS patients—defined as cases in which the decision to call EMS was the patients’ own, rather than a referring physician’s—to evaluate the potential for PC as an alternative option.…”