Nonurgent patients in the emergency department? A French formula to prevent misuse

Abstract

BackgroundOvercrowding in emergency department (EDs) is partly due to the use of EDs by nonurgent patients. In France, the authorities responded to the problem by creating primary care units (PCUs): alternative structures located near hospitals. The aims of the study were to assess the willingness of nonurgent patients to be reoriented to a PCU and to collect the reasons that prompted them to accept or refuse.MethodsWe carried out a cross sectional survey on patients' use of EDs. The study was conducted in a French hospital ED. Patients were interviewed about their use of health services, ED visits, referrals, activities of daily living, and insurance coverage status. Patients' medical data were also collected.Results85 patients considered nonurgent by a triage nurse were asked to respond to a questionnaire. Sex ratio was 1.4; mean age was 36.3 +/- 11.7 years.Most patients went to the ED autonomously (76%); one third (31.8%) had consulted a physician. The main reasons for using the ED were difficulty to get an appointment with a general practitioner (22.3%), feelings of pain (68.5%), and the availability of medical services in the ED, like imaging, laboratory tests, and drug prescriptions (37.6%). Traumatisms and wounds were the main medical reasons for going to the ED (43.5%).More than two-thirds of responders (68%) were willing to be reoriented towards PCUs. In the multivariate analysis, only employment and the level of urgency perceived by the patient were associated with the willingness to accept reorientation. Employed persons were 4.5 times more likely to accept reorientation (OR = 4.5 CI (1.6-12.9)). Inversely, persons who perceived a high level of urgency were the least likely to accept reorientation (OR = 0.9 CI (0.8-0.9).ConclusionsOur study provides information on the willingness of ED patients to accept reorientation and shows the limits of its feasibility. Alternative structures such as PCUs near the ED seem to respond appropriately to the growing demands of nonurgent patients. Reorientation, however, will be successful only if the new structures adapt their opening hours to the needs of nonurgent patients and if their physicians can perform specific technical skills.

PHC re-engineering may relieve overburdened tertiary hospitals in South Africa

“…Similar trends of non-emergency patients visiting the emergency department occur in other parts of the world. [8][9][10] Almost half of the patients arrived after hours (18h01 -06h00), indicating the need for after-hours services in primary healthcare (PHC) facilities as well as district and regional hospitals.…”

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

“…De igual manera los resultados de este estudio coinciden con estudios realizados en otros países. Es así como Gentile, et al (2010) siguiendo la misma metodología de este estudio (mayores de 18, que acudieron por cuenta propia al servicio de urgencias y ser clasificados como no urgentes por el triaje hospitalario) encontraron una media de edad de 36 +/-12 años, que el 71% tenía médicos de cabecera, el 76% acudió directamente al hospital, el 66% lo hizo por dolor, el 38% lo hizo por recursos diagnósticos y el 22% porque no pudieron acceder al MC. Field y Lantz (2006), utilizando una metodología semejante encontraron las siguientes razones dadas por los pacientes para haber acudido por cuenta propia al SUH: 49% porque necesitaban un servicio específico (en la mayoría de los casos, rayos x), el 43% necesitaba tratamiento urgente (rápido) y el 23% no podía utilizar los servicios del médico de cabecera en ese momento.…”

“…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). En Europa también se han realizado importantes estudios al respecto (Béland, et al, 1998;Murphy 1998;Pereira, et al 2001;Bianco, Pileggi, Angelillo, 2003;Duran, et al, 2010;Gentile, et al, 2010). En el caso de España existen bastantes trabajos que dan cuenta de este fenómeno (Alonso, et al, 1993;Sempere, et al, 2001;Sánchez, Cabanillas, 2005;Pasarín, et al, 2006, Márquez et al, 2007 Con el fin de contribuir a mejorar la comprensión sobre la utilización de los SUH por personas con PSBC, se diseñó esta investigación.…”

A cross-sectional profile and outcome assessment of adult patients triaged away from Steve Biko Academic Hospital emergency unit

“…8,13 In this study an average of 19 patients per day were triaged away. This may have had a significant impact on the reduction of crowding in the emergency unit but no data are available to support this view.…”

“…7 Other studies have also shown that emergency units often treat patients who can be treated at primary care centres. 5,8,9 Based on the above it would appear that long waiting times and expenditure at emergency units in South Africa could probably be reduced if non-critical patients presenting to an emergency unit could be referred to primary health care facilities.…”