Utilization of the Emergency Department and Predicting Factors Associated With Its Use at the Saudi Ministry of Health General Hospitals

Abstract

Overuse of emergency rooms (ER) is a public health problem. To investigate this issue, a cross-sectional survey was conducted at the ERs of King Abdul-Aziz Hospital, King Fahd Hospital, and Al-Thaghor Hospital in November 2013 with the aims of estimating emergency service utilization for non-urgent cases, identifying the predictors of ER utilization for non-urgent cases, and measuring patients’ knowledge of primary healthcare centers (PHCCs). Patients were interviewed using a structured questionnaire and the data were analyzed using the Statistical Package for the Social Sciences. We recruited 300 patients; males comprised 50.7% of the sample. A higher proportion of patients with non-urgent cases visited the ER three to four times a year (P=0.001). A higher proportion of patients without emergencies had not attempted to visit an outpatient clinic before the ER (P=0.003). Most patients without emergencies thought the ER was the first place to consult in case of illness. Most patients who visited the ER were single, < 15 years, and had lower incomes. Patients requested ER services for primary care-treatable conditions because of limited services and resources as well as limited working hours at PHCCs. Most patients (90.0%) were knowledgeable about PHCCs, with those of lower education being more knowledgeable. Patients reported long ER waiting times (≥ 3 hours), no organization (85.9%), and lack of medical staff. Overall, overuse of ER services is high at the Ministry of Health hospitals in Jeddah. The risk factors for ER overuse are age < 15 years, singlehood, and low incomes. Policy makers and health providers have a challenging task to control ER overuse. We recommend developing strategies to implement policies aimed at reducing non-urgent ER use as well as making healthcare services more available to the population.

Factors associated with non-urgent visits to the emergency department in a tertiary care centre, western Saudi Arabia: cross-sectional study

“…Most of the non-urgent patients thought that the ED is the first place to seek for in case of sickness. 6 Jeddah city is the second largest city in Saudi Arabia and serves as an entry point for Hajj pilgrims, with a total population of 4.3 million. Total hospital beds per 10 000 population in Jeddah is 7.4 compared with 10 in Riyadh.…”

Assessment of nationwide emergency systems in Thailand, a middle‐income country setting with UHC

“…Our study (Table ) found that the overall figure (33%) for ED visits with nonurgent presentation (NUP) (ESI 4‐5) was similar to the percentage (37% [range 8%‐62%]) of all ED visits in the United States that were judged to be NUP . The figures from a few LMICs such as Saudi Arabia and Iran were 20% to 72% . However, these figures were based on varying definitions across studies, hence rendering difficulty in comparison.…”

“…13 The figures from a few LMICs such as Saudi Arabia and Iran were 20% to 72%. 14,15 However, these figures were based on varying definitions across studies, hence rendering difficulty in comparison.…”

Norms of staff responses to falls in residential care

“…In instances of general emergency care, where patients have genuinely sustained injuries warranting hospital attention, the assessment of a qualified paramedic is invaluable (Halter, Humphreys et al, 2017;Snooks et al, 2017). However, inappropriate use of emergency services also causes a degree of dissonance and frustration in relation to the perceptions that paramedic practitioners hold of those they potentially need to assess, diagnose and manage in the context of an emergency response (Dejean et al, 2016) whether this is related to ambulance use or treatment in hospital (Cardona-Morrell et al, 2017;Franchi et al, 2017;Dawoud et al, 2016). In the context of residential care home settings there was a high degree of ambiguity around the assessment of sustained injuries and whose responsibility this was, particularly in relation to falls where potentially non-visible injuries which were subsequently not immediately identifiable, where patients were moved via hoists.…”