A Qualitative Assessment of Reasons for Nonurgent Visits to the Emergency Department

Abstract

Guardians' concerns about perceptions of severity of illness in children and their schedules must be considered to effectively reduce nonurgent ED use, which may differ from the perceptions of professionals. Health professionals and systems seeking ways to decrease ED utilization may be able to better match capacity to demand both by increasing accessibility to primary care and by working to overcome guardians' perceptions that only EDs can handle acute illnesses or injuries.

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

“…There were multiple reasons why people felt accessing primary healthcare services was difficult. Anticipated waiting times for appointments and PCPs (including GPs) being busy were key factors,40, 41, 42 with one study reporting that 44% of patients found their GP “inaccessible to their needs.” This was also linked to patient perceptions around accessibility and availability of appointments at times of day that were convenient to patients,43 limited PCP opening hours,44 with a small proportion of patients reporting that they were unable to obtain a PCP appointment 38. Lack of primary health service available after hours was raised by one study 18.…”

“…In some cases anxiety was due to worries about the legitimacy of need,39 with patients not wishing to use services inappropriately. There was a strong sense that patients viewed their conditions to be serious 40, 42, 43, 48, 55, 56, 57. This was juxtaposed with evidence that patients were not always capable of assessing which health problems required emergency care and were sometimes unsure of the legitimacy of their health needs 39, 58…”

“…This often stems from a belief that their condition needs the resources offered by a hospital, including hospital doctors (rather than PCPs or GPs) and diagnostics particularly x‐rays and treatment 38, 43, 46, 59. Some patients felt that they were too sick to be seen within a primary care setting, with the study by Lobachova and colleagues57 reporting that 80% of patient felt that they were too ill to be seen and treated in primary care.…”

“…Access to primary care is often viewed as limited, due to more structured opening hours and perceptions around difficulty obtaining appointments, and there is a view that the ED is more convenient due to factors such as 24‐hour availability and not having to make an appointment 38, 43, 49, 55, 62. In one study, 60% of patients viewed the ED as more convenient than their PCP55 and several other studies reported that people chose to visit the ED for low‐urgency problems due to ED being closer or faster,63 the accessibility of the ED,43, 54 the convenience of the ED location,42 or service 40. Conversely, one study reported that patients attended the ED with primary care problems even though few people believed that they would be seen more quickly or that it was more convenient 19…”

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

“…27 Other investigators have observed that factors motivating parents to seek ED care for their infants include the perceived severity of their infant' s illness and the difficulty accessing timely primary care. 28 If it is found that many ED visits for these infants are truly for "assessment" or "parental education" only (without receipt of medications or testing of any kind) then it may be imperative for the medical community to develop strategies to provide improved parental education and convenient access to alternative care venues.…”