Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Abstract

ObjectivesRising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care.MethodsSystematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer‐reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework‐based narrative synthesis.ResultsThirty‐eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty‐nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency‐based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations.ConclusionsWe identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.

Urgent care centre in Sweden—the integration of teams and perceived effects

“…It is evident that ED overcrowding not only increases LOS and jeopardises patients' safety, but it also increases the rate of morbidity and mortality . A recent review revealed that the most common cause for ED crowding is related to the number and type of people attending ED and their timely discharge from ED.…”

“…Many factors contribute to this imbalance, of which some are external (related to other entities) and some internal (involve the ED itself). A systematic review from 2017 showed that the trend of increasing annual demand for emergency care is consistent across developed countries, which may result in an increased length of stay (LOS), poor patient safety, and increased morbidity and mortality. …”

“…The most challenging external factor is the patients' desire to be served instantly for their low‐urgency health problems, either because of incorrect perception of urgency for their condition or insufficient access to or limited trust in the primary health‐care services (overconfidence in special care and facilities) . Such desire results in an overutilisation of ambulance resources and unnecessary search for specialised care at the hospital's ED .…”

Resources spent on dermatological emergency patients: A twelve‐month prospective data collection from Germany

“…Is the issue of crowded emergency departments exacerbated by performing a wide range of diagnostic tests and thus offering a "complete service package" instead of just performing adequate emergency treatment? And what can be done to reverse the ongoing trend of non-urgent consultations in emergency units [3,21,22]?…”

Für dermatologische Notfallpatienten benötigte Ressourcen: Eine zwölfmonatige prospektive Datenerhebung aus Deutschland

“…Wird das Problem überfüllter Notaufnahmen durch den Einsatz einer umfangreichen Auswahl diagnostischer Tests, und damit dem Angebot eines „kompletten Servicepakets“ anstelle einer angemessenen Notfallbehandlung, verschärft? Und was kann getan werden, um dem aktuellen Trend zu Konsultationen, die nicht dringlich sind, in Notaufnahmen entgegenzuwirken ?…”