Abstract
BackgroundFor several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of “nonurgency”.ResultsSemi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients’ use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency.ConclusionsStudies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.
Highlights
For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs
Eighty-seven ED patients were categorized as nonurgent by a triage nurse, and 34 ED health professionals agreed to participate in the study
The majority of patient participants were followed by a primary care providers (PCPs) (82.8%)
Summary
For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Over the past three decades, overcrowding in emergency departments (EDs) has become a serious problem for EDs in several developed countries [1,2,3,4,5] This problem has been extensively described in the emergency medicine literature [1,2,3,4,5,6,7]. Patients who present to EDs often face long waiting times to be treated and, for those who require admission, even longer waits for inpatient hospital beds [9]. This problem was defined by the Australasian College for Emergency Medicine (ACEM) and labelled “hospital access block” [10]. It has been described as an “international symptom of health care system failure” [11]
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