The characteristics of self-referrals to ER for non-urgent conditions and comparison of urgency evaluation between patients and nurses

Rassin, Michal; Nasie, Anat; Bechor, Yair; Weiss, Gali; Silner, Dina

doi:10.1016/j.aaen.2005.10.003

Cited by 16 publications

(23 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sixteen studies only included patients with non-urgent problems. [12, 14, 17, 19, 22, 24, 25, 27, 29–31, 34, 35, 37–39] Sixteen studies made use of questionnaires [3, 5, 12, 13, 16–19, 27, 31–33, 36–39], often with multiple choice questions [3, 5, 12, 13, 16, 19, 22, 27, 33, 37, 39] Three studies performed interviews with qualitative methodologies [29, 30, 34]. Others performed interviews without qualitative methods, sometimes by telephone, or by letting the treating physician or triage nurse ask one open question [14, 15, 20–26, 28, 31, 32, 35].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Motives for self-referral to the emergency department: a systematic review of the literature

Kraaijvanger

Leeuwen

Rijpsma

et al. 2016

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundIn several western countries patients’ use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED without referral. The goal of this systematic review therefore is to explore what motivates self-referred patients in those countries to visit the ED.MethodsRecommendations from the PRISMA were used to search and analyze the literature. The following databases; PUBMED, MEDLINE, EMBASE, CINAHL and Cochrane Library, were systematically searched from inception up to the first of February 2015. The reference lists of the included articles were screened for additional relevant articles. All studies that reported on the motives of self-referred patients to visit an ED were selected. The reasons for self-referral were categorized into seven main themes: health concerns, expected investigations; convenience of the ED; lesser accessibility of primary care; no confidence in general practitioner/primary care; advice from others and financial considerations. A random-effects meta-analysis was performed.ResultsThirty publications were identified from the literature studied. The most reported themes for self-referral were ‘health concerns’ and ‘expected investigations’: 36% (95% Confidence Interval 23–50%) and 35% (95% CI 20-51%) respectively. Financial considerations most often played a role in the United States with a reported percentage of 33% versus 4% in other countries (p < 0.001).ConclusionsWorldwide, the most important reasons to self-refer to an ED are health concerns and expected investigations. Financial considerations mainly play a role in the United States.

show abstract

Section: Resultsmentioning

confidence: 99%

“…The remaining studies were performed in the Netherlands [3, 5, 13, 17, 20], Ireland [15], Denmark [27], USA [29–34], Australia [37, 38], Hong Kong [35], Kuwait [36], and Israel [39] (Table 1). …”

Section: Resultsmentioning

confidence: 99%

Motives for self-referral to the emergency department: a systematic review of the literature

Kraaijvanger

Leeuwen

Rijpsma

et al. 2016

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Yet another set of studies based appropriateness on the opinion of medical professionals. Among these studies the type of medical professionals varied, and included medical students [8], triage nurses [20], ED nurses [21], casualty officers [22], one senior A&E consultant [23] or the treating emergency physician [24]. The methods used were subjective, and because of the opinion-based nature there was a risk of interobserver bias.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies, for instance, have focused on the triage category (using different triage systems) [11][12][13][14], on predefined criteria (mainly with emphasis on diagnostic workup and performed treatment) [5,7,9,[15][16][17][18][19] or on the opinion of various medical professionals [8,[20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Self-referrals in a Dutch Emergency Department: how appropriate are they?

Kraaijvanger¹,

Rijpsma²,

Leeuwen

et al. 2016

European Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…The variability in these numbers can be explained by the variable definitions used to determine ‘inappropriateness’. The definitions of ‘emergency’ , ‘urgency’ and ‘needing hospital emergency care’ are widely debated, and medical professionals and patients differ in what they consider an ‘emergency’ and ‘appropriate visit’ [[21],[22],[24],[25]]. Given the proportion of self-referred patients in our study who did require hospital emergency care - 51% - it seems that many patients are quite capable of assessing their own need for hospital emergency care.…”

Section: Discussionmentioning

confidence: 99%

Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

et al. 2014

View full text Add to dashboard Cite

BackgroundNearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED.MethodsA descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ2 tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression.ResultsOf the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were ‘accessibility and convenience’ and perceived ‘medical necessity’.ConclusionsA substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem.

show abstract

The characteristics of self-referrals to ER for non-urgent conditions and comparison of urgency evaluation between patients and nurses

Cited by 16 publications

References 11 publications

Motives for self-referral to the emergency department: a systematic review of the literature

Motives for self-referral to the emergency department: a systematic review of the literature

Self-referrals in a Dutch Emergency Department: how appropriate are they?

Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral

Contact Info

Product

Resources

About