Factors associated with inappropriate attendances at the emergency department of a tertiary hospital in Singapore

Abstract

Singapore Med J 2020; 61(2): 75-80 https://doi.org/10.11622/smedj.2019041 O r i g i n a l A r t i c l e METHODS We conducted a retrospective cohort study of all eligible visits to the aforementioned ED between 1 January 2015 and 31 December 2015. The appropriateness of each attendance was estimated using criteria based on investigations or procedures that were performed on the attendee and the discharge type of that attendance. IAs were then compared against appropriate attendances in these areas: attendee demographics; referral source; time of ED visit; proximity to ED and 24-hour general practitioner clinics; and history of ED visits in 2014. Multivariate analysis was performed on significant variables associated with IAs. RESULTSAmong 120,606 attendances, 11,631 (9.6%) were IAs. Multivariate analysis showed that gender, ethnicity, referral source, time of ED visit, nationality and history of frequent visits to the ED were factors associated with IAs. Moreover, the odds of IA were found to be higher among attendees who were younger, were self-referred, or had at least one IA in 2014.CONCLUSION This study identified subgroups in the population who were more likely to contribute to IAs at the ED. These findings offer relevant insights into future research directions and strategies that might potentially reduce avoidable IAs.

A Sample of The Relationship Between The Non-Integrated Healthcare System And National Epidemic of Emergency Department Overcrowding In Turkey

“…The fact that non-urgent patients were younger than urgent patients and signi cantly in the 18-44 age group was consistent with other studies in the literature (1,5,13,19). The non-urgent visit rate was signi cantly higher in patients arriving with their means than patients who arrived with ambulances.…”

“…In many studies, it was found that reasonable access to primary care providers such as GPs and continuity of care measured by seeing the same family doctor were essential factors in reducing non-emergency ED visits (24,25). In the current health system, while it may seem that patients being unable to access immediate health service leads them to prefer EDs ( 23), many studies have shown that the level of service, working hours, and increased professionalism do not decrease the use of EDs (5,19,(26)(27)(28).…”

Assessing the cost-effectiveness of mepolizumab as add-on therapy to standard of care for severe eosinophilic asthma in Singapore

“…This disparity is unsurprising as ED attendances and hospitalization rates for asthma in Singapore have been observed to be higher than other developed countries. The reasons are multifactorial, including easy accessibility of EDs resulting in inappropriate visits (33), socioeconomic factors (34,35), a lower level of confidence or competency in self-management among patients (36), and poor adherence to and/or lack of standard protocol in the management of acute asthma in EDs (37,38) (39).…”

The impact of the COVID 19 pandemic on emergency department attendance: What seems to be keeping the patients away?

“…This versatility is very important, especially in the early phases of handling new and emerging infectious diseases, where new information on the offending agent is evolving as we move along. [ 2 8 9 ] From the early stages when Singapore was in Disease Outbreak Response System Condition (DORSCON) Yellow, we move on to DORSCON Orange and have stayed at this level till today[ 10 ] [ Table 1 ].…”