Emergency department use in a rural Australian setting: are the factors prompting attendance appropriate?

Abstract

Increases in attendance rates at emergency departments (EDs) have prompted concerns regarding inappropriate utilisation. Factors instigating patient ED attendance were examined using a cross sectional survey of 522 patients presenting to the ED of a rural hospital in Australia, during a 1-week period. The results highlighted the importance of the rural hospital ED as an additional and alternate service to existing primary care facilities, particularly outside of business hours. The findings indicated that although patients' perception of an emergency does not necessarily correspond with clinical interpretations, the primary factors prompting attendance, including general practitioner unavailability, referrals and special service needs, suggest that, from a patients' perspective, the majority of presenta- A number of studies cite "inappropriate" utilisation of the ED as one of the primary contributors to increasing attendance rates. 3,6,7 However, the lack of a standardised definition of what is "inappropriate" ED utilisation impedes the ability to assimilate and assess previous findings. The different interpretations of inappropriate ED use significantly affect study results, and the classification of inappropriate visits can range from ten to ninety per cent. What is known about the topic? Attendance rates at emergency departments (EDs) throughout the world are steadily increasing, creating a number of concerns for hospitals, including increased pressure on resources, and access block. A number of studies cite "inappropriate" utilisation of the ED as one of the contributors to increasing attendance rates. Studies have attempted to identify, for example, why potential primary care patients choose to attend the ED as opposed to primary care services. What does this paper add?There have been no published Australian studies which have examined ED use in a rural setting. This paper describes ED use from the patients' perspective and highlights the importance of the rural hospital ED as an additional and alternative service to existing primary care facilities, particularly outside normal business hours. What are the implications?The findings indicate that, given the primary factors prompting attendance, including general practitioner unavailability, referrals and special service needs, in most cases the ED attendance was justified and thus could be deemed appropriate. Further studies need to be undertaken to explore ED utilisation in more depth to assist in formulating policies and strategies to support ED service delivery.

Unplanned oncology admissions within 14 days of non-surgical discharge: a retrospective study

“…Many unplanned presentations for cancer patients' symptom management are nonurgent, so admission without prior physical assessment is likely to create an unnecessary burden on inpatient resourcing [3,14,17]. Additionally, non-urgent ED presentations have risen in Australia with the decline in bulk billing practices by general practitioners [14].…”

“…They provide vital services to people who require urgent care. Patients with cancer who become unwell often present to the ED for review because they do not want to Bbother their health care providers^ [14]. However, this point of assessment and entry is not available at the study hospital nor is an assessment area or team.…”

“…Cancer patients and their families consider the need for review as urgent when symptoms develop or worsen [3,9,[14][15][16][17]. Admission to the study hospital is often facilitated by nurses in the cancer centre taking telephone triage calls and relaying the content of the information recorded to the treating oncologist, often leading to a directive to admit the patient without prior medical review.…”

The factors that influence private health insurance holders' choice between public and private emergency departments at the time of emergency

“…Other health needs factors such as patients' perceived severity of illness and patients' health status were also associated with demand for emergency care (Baker, D. W. et al, 1995;Bazargan et al, 1998;Bianco et al, 2003;Callen et al, 2008;Lee et al, 2000;Olsson & Hansagi, 2001;Selasawati et al, 2007).…”

“…Among these perceptions, perceived severity of the condition (Baker, D. W., Stevens, & Brook, 1995;Callen, Blundell, & Prgomet, 2008;Selasawati, Naing, Wan Aasim, Winn, & Rusli, 2007)was found to be the most frequently identified.Other perceptions include the perceived quality of care provided by EDs (Lee et al, 2000;Ragin et al, 2005), current perceived symptoms (Backman, Blomqvist, Lagerlund, Carlsson-Holm, & Adami, 2008), and perception of convenience (Ragin et al, 2005). Patient beliefs play a role in demand for ED service.…”