Characteristics of Non-Emergent Visits in Emergency Departments: Profiles and Longitudinal Pattern Changes in Taiwan, 2000–2010

Huang, Lien‐Hung; Chung, Wu Fu; Liu, Shih Wei; Wu, Jau Ching; Chen, Li Fu; Chen, Yi Chun

doi:10.3390/ijerph16111999

Cited by 4 publications

(8 citation statements)

References 49 publications

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“…The rate of non-emergent ED visits (9.9%) was lower than those reported in previous studies which are between 4.8% and 90% [ 4 , 18 , 19 ]. Although the rates of ED use vary by country and region due to these different definitions, some factors such as socioeconomic conditions, hospital admission policy, private health insurance coverage, personal health system utilization, and chronic disease profile of the population have been shown to drive geographical variation in ED visits [ 4 , 20 , 21 ]. The most challenging part of these studies was determining non-emergent ED visits, which were largely estimated, relying on diagnostic criteria or the judgment of clinical staff in previous studies [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

Dündar

Yaylaoglu

2022

Arch Public Health

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Background The Turkish government liberalized national healthcare policies in 2008 enabling Turkish citizens to seek general care in hospital emergency departments (ED). The number of ED visits has exceeded the total population every year for the last ten years. To explain this phenomenon and to identify trends and risk factors for non-emergent visits, we retrospectively reviewed the ED records of a tertiary hospital and the Turkish Ministry of Health bulletin. Methods This retrospective record-based study was conducted at a tertiary hospital in Samsun province of Turkey. A total of 87,528 records of adult patients who visited the ED between January 1 and December 31, 2017, were included in this study. We evaluated the pattern of ED use for non-emergent patients by age, gender, nationality, time of visit, means of arrival, ICD (International Classification of Diseases) diagnostic codes, triage codes, number of repeated and out-of-hours visits. We used the Turkish Ministry of Health statistics bulletins to compare the number of ED visits across the country by year. Results The non-emergent visit rate in ED was found 9.9%. The rate of non-emergent ED visits was significantly higher in the 18-44 age group, in the female gender, and in those who arrived at the ED without an ambulance. The number of non-emergent visits was very similar between weekends and weekdays but was significantly higher in working hours on weekdays than out-of-hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeat visits was 14.8% of non-emergent ED visits. According to binary logistic analysis, non-emergency visits were associated with 18-44 age group (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). Conclusions Our results showed that the 18-44 age group and female gender seek care in the ED for non-emergent problems more than the other parts of the population. The numbers of ED visits in the last decade continued to increase regardless of population growth. The health policy changes may have facilitated access to rapid physical and laboratory examination but also an exacerbation of the free-rider problem in ED services.

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Section: Discussionmentioning

confidence: 99%

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

Dündar

Yaylaoglu

2022

Arch Public Health

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“…Unnecessary ED visits, which are defined as ED visits amenable to intervention by ambulatory care due to low acuity (LA), 19 20 have been analysed to estimate inefficiency or waste in emergency care systems. 2 4 14 21 Since the 1990s, several studies have conducted investigations into preventable ED visits. 19 20 22 The concerns regarding adverse consequences of LA visits are that LA ED visits may worsen ED overcrowding; thus affecting the quality of ED care, 23 24 and adding to the inefficiency in healthcare delivery by levying excessive cost on health systems.…”

Section: Introductionmentioning

confidence: 99%

“… 20 24 Studies have revealed an increasing trend of ED utilisation in many countries with different healthcare systems, 4 5 14 21 25 26 but only a few have investigated changes in LA ED over time. 2 11 27 Although single-centre and multi-centre studies have estimated that 20%–65% of paediatric ED (PED) visits are likely to be classified as LA, 2 15 28 29 none of these studies specifically focused on the changes in LA PED visits in the paediatric population over time. The paediatric population is the main user of ED services 27 and a main contributor to LA ED visits.…”

Section: Introductionmentioning

confidence: 99%

“…The high costs of emergency medical services and overcrowding of emergency departments (EDs) make the increasing number of ED visits a serious concern. [1][2][3][4][5] It would be expected that the recent global movement towards expansion of health insurance coverage would result in improved access to primary care or preventative services, thus reducing hospital ED visits. However, other studies have suggested the opposite may occur, [6][7][8][9][10] where the expansion and comprehensiveness of health insurance coverage may, on the other hand, increase the utilisation of hospital ED.…”

Section: Introductionmentioning

confidence: 99%

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Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

Huang

Chou²,

Chou

et al. 2021

BMJ Open

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ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.

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“…Ed is always convenient providing nonstop care by trained specialized team. According to some studies; it has been proved that a higher rate of nonemergency application is noticed in case of unavailability of primary health care centers access and during off-clinic hours [2]. The delayed appointments, and the lack of access to outpatient clinics on evenings and weekends is usually influencing the patient's attitude.…”

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confidence: 99%

Non-emergency applications

2019

JMR

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Overcrowding in emergency departments (ED) could delay and alter the quality of critical services provided. Despite the generalization of developed triage system, the rate of nonurgent applicants is still considerable worldwide. This usually leads to long waiting patients lists, healthcare practitioners over stress, and patients unsastisfaction. A recent literature review reported that between 4.8% to 90% of ED patients were potentially nonurgent cases and the sudden death cases reported in ED should be simply urgent; long waiting unmanaged cases [1]. Among the leading reasons for unsuitable use of ED for “nonurgent complaints.”; patients related factors are most frequent. Elderly patients with heavy chronic conditions and lack of familial support are frequent ED users. Some patients prefer the ED due to the easy access and availability of all investigation tools. Ed is always convenient providing nonstop care by trained specialized team. According to some studies; it has been proved that a higher rate of nonemergency application is noticed in case of unavailability of primary health care centers access and during off-clinic hours [2]. The delayed appointments, and the lack of access to outpatient clinics on evenings and weekends is usually influencing the patient’s attitude. Interestingly, some other reports showed that most of the patients admitted to the ED with mild and simple complaints are well educated, have good social status and do not have chronic diseases [3]. For these cases, wrong perception could be bilateral. The patient is always considering his personal case as extremely urgent; and the health practitioner could not infirm the emergency before the investigations. This risk-averse patient risk-averse doctor relationship could explain the major part of non-emergency applications [4]. With these overwhelmed available resources, the increase of nonurgent visits results in risks for patient safety. This problematic has been recognized long time ago. Since early 90s many triage systems were implemented. However only five level triage instruments are significantly correlated with resource utilization, rate of admission for inpatient treatment, duration of emergency management, and frequency of transfer to intensive care or mortality. Unfortunately, these instruments could not be generalized to all ED [5]. Several other solutions have been proposed. Gatekeeping; redirecting patient systems, or health services cost sharing were not enough and difficult to implement. The benefit a financial penalty for patients categorized as nonurgent after the consultation or targeting frequent users by case management approach is still unclear [6]. In our point of view; the solution to decrease the rate of nonurgent visits is outside of emergency room and not inside. The only valuable option is to provide an alternative to ED by improving the outpatient departments and primary healthcare centers services quality. With patient large sensibilization, the benefit should be perceptible.

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Characteristics of Non-Emergent Visits in Emergency Departments: Profiles and Longitudinal Pattern Changes in Taiwan, 2000–2010

Cited by 4 publications

References 49 publications

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

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