Inappropriate use of emergency services: a systematic review of prevalence and associated factors

Maria Laura Vidal Carret,Ana Claudia Gastal Fassa,Marlos Rodrigues Domingues

doi:10.1590/s0102-311x2009000100002

Abstract

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. The review included 31 articles published in the last 12 years. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were also associated with inappropriate ED use. Thus, primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is also necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent.

Highlights

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors
The prevalence and factors associated with inappropriate ED use varied widely, depending mainly on the criteria used and the study population
The definition ends up including problems that require immediate attention, but which occur when the primary health care facility is open and operating and could be resolved at this level of care

Summary

Introduction

This systematic review aimed to measure the prevalence of inappropriate emergency department (ED) use by adults and associated factors. Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician showed more inappropriate ED use, with the relative risk varying from 1.12 to 2.42. Difficulties in accessing primary health care (difficulties in setting appointments, longer waiting periods, and short business hours at the primary health care service) were associated with inappropriate ED use. Primary care requires fully qualified patient reception and efficient triage to promptly attend cases that cannot wait. It is necessary to orient the population on situations in which they should go to the ED and on the disadvantages of consulting the ED when the case is not really urgent

Methods

Results

Conclusion