A review of health professional attitudes and patient perceptions on ‘inappropriate’ accident and emergency attendances. The implications for current minor injury service provision in England and Wales

Abstract

Increasing attendances in accident and emergency (A and E) departments in the United Kingdom have been attributed to a greater number of patients presenting with minor injuries. A and E staff believe this type of patient is suitable for primary care, and is 'inappropriate' for A and E management. Thus, A and E staff find 'inappropriate' attenders time-consuming and unrewarding, and are less motivated to help them, whilst 'inappropriate' patients believe they have attended the appropriate service for their medical needs and expectations. This review examines research into health professional and patient attitudes towards 'inappropriate' attendances in accident and emergency. It identifies a discrepancy between health professional and patient perspectives regarding 'inappropriate' attendances. However, the change in accident and emergency services with the development of minor injury units and nurse practitioners within A and E to treat minor injury patients away from the mainstream A and E service, appears to be based on the professional attitude of what constitutes an appropriate A and E attendance, and not on the patients' perspective. As negative attitude formation towards 'inappropriate' A and E attendances has occurred, there is concern that such attitudes could remain or develop again in the new units. Patients are generally not medically trained and may experience difficulty in ascertaining the severity of their own condition and attending the 'appropriate' service, as defined by trained professionals. This is exacerbated by the unclear boundaries and roles of minor injury units, nurse practitioners and general practitioners in minor injury care. Therefore research is required into current attendances in minor injury units, A and E departments and general practice, in order to develop clear roles and boundaries for these services. More importantly, research is warranted into the attitudes of all minor injury care providers towards attending patients, and into patient perceptions of the services offered.

Emergency department visits: Why adults choose the emergency room over a primary care physician visit during regular office hours?

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“…[9,16] Moreover, studies have recognized that the perspectives of patients, who generally have little to no medical training or knowledge, are substantially different from the opinion of health care providers. [2,6,7,9,15] An analysis of the triage systems of identification of non-emergent versus emergent conditions revealed that most triage processes have poor sensitivities and specificities with regards to determining the two conditions. [17] With such errors among the medically trained, it is unreasonable to expect that patients would have the knowledge necessary to accurately "self-triage" themselves to the proper facility of care.…”

Use of Out-of-Hours Services: The Patient’s Point of View on Co-Payment a Mixed Methods Approach

“…Rarely the patients perceptions, ideas or concerns were studied (35,36). Former research elicits their need for information about the different tasks of the services, reorganisation and accessibility of primary care during out-of-hours and triage (37)(38)(39)(40)(41).…”

Utilización por cuenta propia de los Servicios de Urgencias Hospitalarias: razones que dan las personas con problemas de salud de baja complejidad para utilizar estos servicios

“…Este fenómeno viene siendo estudiado de manera significativa desde la década de los 90 del siglo pasado hasta el presente, particularmente en Estados Unidos. (Driscoll, Vincent, Wilkinson, 1987;Liggins, 1993;Afialo et al, 1995;Gill, Riley, 1996;Gill, 1999;Sanders, 2000;Sarver, et al 2002;afial, et al, 2004;Howard, et al, 2005;Northington, Brice, Zou, 2005;Carret, Fassa, Domínguez, 2009). La mayor parte de los estudios han sido realizados en Estados Unidos debido a la naturaleza de su sistema sanitario, que carece de un sistema de salud universal, por lo que la mayoría de personas de escasos recursos se ve obligada a utilizar los servicios de urgencias hospitalarios porque carecen de otra fuente de atención o de un seguro privado de salud (Rust, et, al, 2008).…”