Pattern of inappropriate cases presenting to the Accident and Emergency Department in a Nigeria Tertiary Hospital

Abstract

Background: Although the primary mission of the Accident and Emergency Department (AED) is to provide initial treatment for life-threatening conditions, some patients make inappropriate use of the service. This study is aimed to determine the level of inappropriate use and the morbidity pattern of such patients presenting to the department in a tertiary hospital in Nigeria. Materials and methods: A cross-sectional descriptive study in which inappropriate users of the AED of University of Port Harcourt Teaching Hospital were recruited. Data on socio-demographic characteristics and diagnoses based on ICPC-2 were collected from them and analysed using SPSS version 17. Results: A total of 430 patients were recruited with age range of 18-62 years and mean of 38.45 ± 7.2 years. Considering the socio-demographic characteristics, only the association between gender and utilisation of the AED was statistically significant (p = 0.014). The prevalence of inappropriate use of the AED was 37.7%. The most frequent diagnosis among inappropriate users using the ICPC rubrics was polyuria and glycosuria (9.88%). When the cases were listed by the organ systems according to ICPC chapters, it was found that the commonest diagnoses were gastrointestinal (20.9%) and general and unspecified conditions (17.7%). Psychological conditions were not identified in this study. The most common reason for inappropriately presentation at the AED was patients referring themselves for quick attention (46 . 3%). Conclusions:The level of inappropriate utilisation of the accident and emergency department was very high in this institution. Creation of public awareness will curtail this sickness behaviour.

Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria

“…Only one-third of the self-referrals presented during morning shift in our study. This is similar to findings by Opunabo et al in Port Harcourt, Nigeria 29. The high prevalence of self-referrals at our centre may be because acutely-ill children present a challenge and dilemma to the parents, who reflexly or in desperation, sought for immediate medical assistance at CHER, even at odd hours.…”

“…The high prevalence of self-referrals at our centre may be because acutely-ill children present a challenge and dilemma to the parents, who reflexly or in desperation, sought for immediate medical assistance at CHER, even at odd hours. However, studies have shown that majority of self-referrals to emergency departments (ED) are not appropriate patients for emergency units 29,38–40…”

“…Hence a tertiary care facility like ours, which is supposed to concentrate on managing critical and complex cases, is being overburdened. Research had identified three factors that can lead to overcrowding of ED as: input factors, throughput factors and output factors 27–29. Primary and secondary health care facilities should be strengthened in order to reduce self-referral to tertiary centres in the Country.…”

“…However, factors such as patient inflow, CHER admission and discharge processes, as well as hospital bottlenecks and level of facilities may contribute to prolonged hospital stay. Prolonged hospital stay may cause: socio-cognitive problems to the child; socio-economic burdens to the parents and increased constraints on the health facility resources 27–29…”