Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients

Abstract

BackgroundFor several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of “nonurgency”.ResultsSemi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients’ use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency.ConclusionsStudies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.

A satisfação do usuário com a atenção primária à saúde: uma análise do acesso e acolhimento

“…This problem has been researched in different countries and is a current reality in primary healthcare services. 5,24 Not meeting spontaneous demands was another factor that generated dissatisfaction among PHC users. Furthermore, the participants reported missing the days in which appointments could be scheduled, making it even more difficult to obtain medical care.…”

Emergencies and Disaster Medicine

“…En effet, les deux facteurs organisationnels affectant la satisfaction des patients sont directement liés à la problématique de l'encombrement des urgences. Il n'existe pas de définition universel des 'patients non urgents' [21,22]. la littérature a décrit une très grande variabilité dans la proportion des patients non urgents (4.8 à 90%) ; un manque de reliabilité et de reproductibilité des méthodes et les critères de catégorisation des patients aux urgences [23].…”

Emergency department enlargement in China: exciting or bothering

“…These patients played an important role in the problem of ED overcrowding and enlargement. Accessibility to health care resources and the context in which the medical problem occurred were the reasons for non-urgent patients search help in ED (11). Improve the level of medical service provided by the basic general hospital, provide nighttime outpatient service and promote multi-sited license of doctors might be critical to solve this problem.…”