Nonurgent Emergency Department Research Articles

Association between socioeconomic status and nonurgent presentations to pediatric emergency departments: a retrospective study.

Access to healthcare remains a persistent challenge. Socially disadvantaged populations often encounter barriers to care and may frequently seek out emergency departments (EDs), including for nonurgent medical care. The objective of this study is to study the association between nonurgent presentations to pediatric EDs and patients' socioeconomic environment in an urban setting. A retrospective study of all visits to a pediatric ED in eight participating centers of the Paris metropolitan area (France) between 1 January 2017 and 31 December 2021 was carried out. Routinely collected data were analyzed. Socioeconomic status was evaluated using ecological variables defined at the municipality level. These variables were collected from public sources and included a social deprivation index, the accessibility to general practitioners, the proportion of single-parent families, and the proportion of immigrants. The primary endpoint was a nonurgent ED presentation, defined as being assigned one of the two lowest triage categories on a five-point scale. A multilevel logistic model assessed the association between nonurgent ED presentations and patients' characteristics, socioeconomic environment, and healthcare accessibility. Nonurgent visits accounted for 51.6% of the 1 499 108 visits during the study period. The admission rate was 2.1% for nonurgent presentations and 18.8% for urgent presentations. In the final multivariate model (n = 1 412 895 visits), after adjustment for sex, age, time of day, day of the week, month, and year, the risk of nonurgent presentation was significantly higher for children living in less advantaged areas and in areas where the rate of single-parent families was high. It was also higher for children living close to the ED. This extensive retrospective multicenter study emphasizes the increased risk of visiting EDs for nonurgent medical care among children from disadvantaged urban areas.

Addressing the overuse of hospital emergency departments in the Portuguese NHS: a new paradigm.

The escalating trend of inappropriate visits to Emergency Departments (ED) has led to significant concerns, including resource misallocation, compromised patient care, and an increased burden on healthcare workers. Portugal faces a notable challenge, reporting one of the highest per capita ED visit rates, with an annual average of approximately 6 million ED visits from 2013 to 2023. In response, the "Call First, Save Lives" pilot project was launched by the Portuguese NHS Executive Board, in 2023, at the Local Health Unit (LHU) of Póvoa de Varzim/Vila do Conde. This project leverages the SNS 24 telephone triage system to direct patients to the most appropriate care settings, alleviating pressure on ED, and optimizing healthcare resources. The project introduced several strategic enhancements, including optimizations of the SNS 24 system and inter-institutional initiatives to promote interoperability, hospital follow-ups for chronic conditions, and a "reverse referral" system directing non-urgent ED cases to Primary Care Services (PCS). In PCS, the project expanded acute care consultations and introduced complementary health services. The initiative also emphasized communication to improve health literacy and appropriate utilization of the NHS, supported by legal framework development. Since the beginning of the project, the number of calls received by SNS 24 showed an upward trend, both at the local, 27.6%, and national level, 44.5%, having already expanded to other LHU. Nonetheless, challenges such as the "reverse referral" process complexity, healthcare information systems integration, and procedural standardization need addressing, with future plans including satisfaction surveys and patient triage protocol refinements to improve service delivery and patient adherence.

Impact of urgent care centers on emergency department visits in Al Madina Al Munawara: A pre-post study.

To evaluate the impact of UCCs on reducing non-urgent Emergency Department (ED) visits and improving patient flow, focusing on metrics such as door-to-doctor time, doctor-to-decision time, and overall patient disposition. This observational cohort pre-post study analyzed data from 198,050 ED visits to King Fahad Hospital, Al Madina Al Munawara between June 2021 and May 2023 and compared visit patterns before and after UCC implementation. Post-UCC implementation, the average door-to-doctor time decreased but was not statistically significant. Significant reductions were observed in doctor-to-decision and door-to-disposition times for CTAS 3 patients. However, overall patient flow improvements were not fully realized, highlighting the need for enhanced public awareness and integration of UCCs with EDs. The study shows that while urgent care centers in Al Madina Al Munawara have improved efficiency for some patient categories, they don't fully achieve expected reductions in waiting times and patient flow. Seasonal variations, limited patient awareness, and data constraints affect outcomes.

Gather "Round": An Integrated Care Model for the Emergency Department Multi-Visit Patient.

Emergency departments (EDs) are a vital component of the United States healthcare system and care for over 130 million patient visits annually. Nonurgent ED visits can contribute to crowding, delays in care, and adverse effects. Many high-utilizing ED patients may present with complex medical, behavioral, and social needs that are not necessarily emergent or urgent in nature. The authors created an Integrated Care Model, called the Multi-Visit Patient (MVP) program, for patients with 5 or more visits to the ED in a rolling 12-month period. The MVP program incorporated an interdisciplinary group of ED leadership and case management (CM) to identify, engage, and intervene with ED MVPs, aiming to improve their ED utilization. Patients received comprehensive screenings for depression, falls, alcohol use disorder, caregiver support, social determinants of health, and more. Based on these screenings, the CM team implemented interventions such as connecting patients with outpatient specialists and linking patients to community-based organizations to optimize stability, wellness, and reduce ED utilization. The collaboratively developed MVP program was implemented in the ED of a large, suburban, tertiary care academic hospital. The MVP program identified 221 MVP patients over a 20-month period and successfully connected with 89% of them. Of these 221 patients, 78% (172 patients) chose to engage in the MVP program, with 160 completing their engagement with an outcome. Among the patients who completed their engagement and for whom the study could match separate utilization data (151 patients), the study observed a 57% reduction in ED visits. Case managers play a crucial role in the effectiveness of the MVP program by coordinating comprehensive care for high-utilizing ED patients. The MVP program includes transition of care initiatives designed to improve patient outcomes. Through screenings and targeted interventions, case managers identify and address the complex medical, behavioral, and social needs of MVP patients. This collaborative, interdisciplinary approach underscores the importance of timely and coordinated care, benefiting both patients and the health system. The MVP program exemplifies the critical role of case managers in reducing unnecessary ED visits and enhancing overall patient care.

National estimates of nonurgent emergency department utilization for sportsrelated injuries in high school-age population.

Athletic trainers (ATs) can manage nonurgent, musculoskeletal emergency department (ED) visits. Little is known about what populations are most likely to use the ED for nonurgent, sports-related musculoskeletal injuries. Our object is to provide national-level evidence on whether high-school age population with public insurance or lower socioeconomic status were more likely to have ED visits for nonurgent injuries. Cross-sectional study. Secondary data analysis of the 2017-2019 Nationwide Emergency Department Sample (NEDS). ED visits for high school-age patients with a sports-related musculoskeletal injury. We used a multi-step process and AT scope of care threshold to classify ED visits for musculoskeletal injuries as urgent and nonurgent. National estimates of the proportions of visit, patient, and hospital characteristics by urgent, nonurgent, and total injury ED visits were reported. Survey weighted logistic regression was used to calculate odds ratios of an ED visit being for a nonurgent injury based on a patient's insurance type and socioeconomic status. For ED visits for musculoskeletal injuries in a high school-age, sports exposed population, 52.93% (95% CI: 51.11, 54.73) were for nonurgent injuries. Patients with public insurance were more likely (OR = 1.39; 95% CI: 1.35, 1.44) to have an ED visit for a nonurgent injury compared to ED visits for patients with private insurance. Patients from the lowest estimated neighborhood income quartiles were more likely (OR = 1.10; 95% CI: 1.02, 1.20) to have an ED visit for a nonurgent injury compared to ED visits for patients in the highest estimated income quartile. Our results suggest opportunities to reduce nonurgent ED use using AT services exist, especially in high school-age athletes from vulnerable populations.

Low caregiver health literacy is associated with non-urgent pediatric emergency department use.

Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use. This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method. The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta. Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.

The impact of SARS-CoV-2 on emergency health care demand: inverse relationship between COVID-like illnesses and ED accesses in Genoa, Italy.

SARS-CoV-2 has changed the demand for in-person health care. The aim of this study was to retrospectively analyzed data on access to San Martino Hospital Emergency Department (ED), Genoa, Italy, during the COVID-19 pandemic. Descriptive statistics for 180,117 records of patients accessing the ED between 2019 and 2021 were reported. A linear regression model was built to evaluate the relationship between the weekly number of COVID-like illness cases and ED attendances. In comparison to pre-pandemic levels, the median number of ED visits declined by 41.6% in 2020 and by 27.4% in 2021. The period of maximum drop in access (-61.9%) was the 2020 12-16th calendar weeks and coincided with the highest rates of COVID-like illness cases (+360%; 22.8% of total ED attendances). About 20% of the variation of the weekly number of ED attendances was explained by the number of COVID-like illness cases. In 2020 and 2021 non-urgent ED codes decreased (-6.7%; -7.3%) and both urgent and emergency ED codes increased (+4.8% and +3.9% the first; +1.9% and +3.5% the second). However, the absolute number of ED access fell drastically for all codes. In particular, the highest increase was registered in 2020 for acute respiratory infections (ARI), including COVID-19 (+3.28%), while traumas and eye diseases saw the highest decrease (-1.02%; -3.80%). While the reduction in non-urgent visits suggests avoidable pre-pandemic access levels, the decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care.

Primary Care Enhanced Access Services and the Association With Nonurgent Pediatric Emergency Department Utilization and Child Opportunity Index.

This study aims to examine the association between primary care practice characteristics (enhanced access services) and practice-level rates of nonurgent emergency department (ED) visits using ED and practice-level data. Survey data suggest that enhanced access services within a child's primary care practice may be associated with reduced nonurgent ED visits. We performed a cross-sectional analysis of nonurgent ED visits to a tertiary pediatric hospital in Western Pennsylvania with nearly 85,000 annual ED visits. We obtained patient encounter data of all nonurgent pediatric ED (PED) visits between January 2018 and December 2019. We identified the primary care provider at the time of the study period. For each of the 42 included offices, we determined the number of unique children in the office with a nonurgent PED visit, allowing us to determine the percentage of children in the practice with such a visit during the study period. We then stratified the 42 offices into low, intermediate, and high tertiles of nonurgent PED use. Using Kruskal-Wallis tests, logistic regression, and Pearson χ 2 tests, we compared practice characteristics, enhanced access services, practice location Child Opportunity Index 2.0, and PED visit diagnoses across tertiles. We examined 52,459 nonurgent PED encounters by 33,209 unique patients across 42 outpatient offices. Primary care practices in the lowest ED visit tertile were more likely to have 4 or more evenings with office hours (36% vs 14%, P = 0.04), 4 or more evenings of weekday extended hours (43% vs 14%, P = 0.05), and at least 1 day of any weekend hours (86% vs 29%, P = 0.01), compared with practices in other tertiles. High PED use tertile offices were also associated with lower Child Opportunity Index scores. Primary care offices with higher nonurgent PED utilization had fewer enhanced access services and were located in neighborhood with fewer child-focused resources.

CAN REFERRAL TO COMMUNITY-BASED EXERCISE PHYSIOLOGIST SERVICES REDUCE EMERGENCY DEPARTMENT BURDEN? A CHART AUDIT

INTRODUCTION &amp; AIMS Despite the rapid growth of exercise physiology in Australia, its potential within the healthcare system remains underutilised. Healthcare system strain, characterised by increased emergency department (ED) waiting times and length-of-stay is exacerbated by preventable, non-urgent ED attendances. In 2022, musculoskeletal conditions constituted the majority of &amp;gt;800,000 non-urgent ED presentations. Community care and underutilised allied health services, such as exercise physiology, may offer better management options. This study aimed to examine characteristics of patients presenting to ED for musculoskeletal conditions, treatment advice provided on physical activity, and referral practices to community-based exercise physiology services. METHODS A retrospective chart audit (n=267) examined patient characteristics, referral patterns and treatment advice due to non-urgent musculoskeletal conditions at Eastern Health EDs. RESULTS Most (n=223, 84%) patients presented with conditions that had persisted for a mean (SD) duration of 9.3 (32.4) days. Conditions affecting the leg (n=92, 34%), lower back (n=59, 22%) and arm (n=44, 16%) were most common. Sharp pain was the most common descriptor of pain (n=33, 12%). Almost half (45%, n=119) had comorbid cardiovascular disease (n=59, 22%), metabolic conditions (n=31, 12%) or mental health issues (n=29, 11%). Treatment advice on physical activity was provided for 17% to patients with 12% advised to avoid physical activity (n=31, 12%) and 5% to stay active (n=12). Advice to return to (n=2, 1%) or take time off (n=47, 18%) work was provided for 19% (n=49) patients. No patients were referred to exercise physiology services. CONCLUSION Patients presenting to EDs for musculoskeletal conditions appeared suitable for referral to community-based exercise physiology services, yet no referrals were identified. Moreover, few patients received advice on whether to stay active or avoid physical activity. Strategies to increase external ED referral to exercise physiology are warranted to alleviate burden within this setting.

Impact of the COVID-19 pandemic on regular emergency department users.

Regular users of the emergency department (ED) include both patients who could be better served in lower-acuity settings and those with high-severity conditions. ED use decreased during the COVID-19 pandemic, but patterns among regular ED users are unknown. To determine the impact of the COVID-19 pandemic on this population, we examined quarterly postpandemic ED utilization among prepandemic regular ED users. Key subgroups included prepandemic ED users with regular visits for (1) low-severity conditions and (2)high-severityconditions. An event study design with COVID-19 and historic controls cohorts. We identified 4710 regular ED users at baseline and followed their ED utilization for 7 quarters. We used a generalized estimating equations model to compare the relative quarterly percent difference in ED visit rates between the COVID-19 and historic controls cohorts. The first postpandemic quarter was associated with the largest decline in ED visits, at -36.0% (95% CI, -42.0% to -29.3%) per regular ED user overall, -52.2% (95% CI, -69.4% to -25.3%) among high-severity users, and -29.6% (95% CI, -39.8% to -17.8%) among low-severity users. However, use did not statistically differ from expected levels after 5 quarters among all regular ED users, 1 quarter among high-severity users, and 3 quarters among regular low-severity users. Initial reductions among regular high-severity ED users raise concern for harm from delayed or missed care but did not result in increased high-severity visits later. Nonsustained declines among regular low-severity ED users suggest barriers to and opportunities for redirecting nonurgent ED use to lower-acuity settings.

Analyzing Non-urgent Emergency Department Visits: Patterns, Demographics, Motivations, and Triage System Awareness in Al-Qassim.

This cross-sectional descriptive study aimed to ascertain the prevalence of non-urgent cases, investigate gender and age preferences, and explore factors influencing individuals' selection of the emergency department (ED) for non-urgent cases in the Al-Qassim region of Saudi Arabia. From July 15, 2022, to December 31, 2022, a structured online questionnaire via a Google Docs survey collected data. The study sampled 425 patients from two prominent Al-Qassim healthcare institutions: Buraydah King Fahad Specialized Hospital and Buraydah Central Hospital. Encompassing patients aged 20 to 80 admitted to the ED between 8:00 and 16:00, concurrent with primary healthcare center availability, the study categorized participants by urgency using the Canadian Triage and Acuity Scale (CTAS) criteria. Data analysis employed descriptive statistics, chi-square tests, and probit regression in R version 4.3.3, with a significance level of p< 0.05 for result interpretation. In Al-Qassim in 2022, 82.4% of ED visitors sought care for non-urgent cases, while 17.6% sought care for urgent cases. No statistically significant relationship was found between age and gender and urgent ED visits. Among those with non-urgent conditions, the top reasons for bypassing primary healthcare services were slow treatment (52.7%), lack of knowledge about primary healthcare (PHC) services (33.9%), and appointment unavailability (5.5%). Evaluation of awareness of the ED triage system showed a significant difference only among patients with excellent awareness. The investigation found a higher prevalence of non-urgent cases, especially among females. Challenges in appointment booking, accessibility, and the perception of urgency were key factors leading patients to choose the emergency department over PHC centers. The study emphasized the crucial role of ED triage system awareness and the impact of satisfaction with PHC services on healthcare-seeking behavior, with younger individuals less likely to visit the ED and males more inclined at specific satisfaction levels.

Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study.

Recent anecdotal reports suggest increasing numbers of people experiencing homelessness are visiting emergency departments (EDs) during cold weather seasons due to inadequate shelter availability. We examined monthly ED visits among patients experiencing homelessness to determine whether there has been a significant increase in such visits in 2022/2023 compared to prior years. We used linked health administrative data to identify cohorts experiencing homelessness in Ontario between October and March of the 2018/2019 to 2022/2023years. We analyzed the monthly rate of non-urgent ED visits as a proxy measure of visits plausibly attributable to avoidance of cold exposure, examining rates among patients experiencing homelessness compared to housed patients. We excluded visits for overdose or COVID-19. We assessed level and significance of change in the 2022/2023year as compared to previous cold weather seasons using Poisson regression. We identified a total of 21,588 non-urgent ED visits across the observation period among patients experiencing homelessness in Ontario. Non-urgent ED visits increased 27% (RR 1.24 [95% CI 1.14-1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 70% (RR 1.68 [95% CI 1.57-1.80]). Among housed patients, non-urgent ED visits did not change significantly during this time period. Rates of ED visits plausibly attributable to avoidance of cold exposure by individuals experiencing homelessness increased significantly in Ontario in 2022/2023, most notably in Toronto. This increase in ED visits may be related to inadequate access to emergency shelter beds and warming services in the community.

Low-Acuity Pediatric Emergency Department Utilization: Caregiver Motivations.

Proper emergency department (ED) utilization is a hallmark of population health. Emergency department overcrowding due to nonurgent visits causes increased stress to healthcare staff, higher costs, and longer wait times for more urgent cases. This study sought to better understand post pandemic reasons caregivers have when bringing in their children for nonurgent visits and devise effective interventions to improve caregiver choice for non-ED care for nonurgent conditions. Surveys were conducted at an urban pediatric hospital for Emergency Severity Index (ESI) level 3 to 5 visits. A total of 602 surveys were completed with 8 being excluded from analysis. Survey responses and anonymized demographic information were collected. Responses were compared between surveys grouped by respondent age category, relation to child, child's race, insurance type, and ESI levels. Primary reasons given for nonurgent ED visits were perceived urgency (74.2%, n = 441), ED superiority to other locations (23.9%, n = 142), and referral to the ED by a third party (17.7%, n = 105). Of those who cited perceived urgency as a reason, 80.5% (n = 355) wanted to lessen their child's pain/discomfort as soon as possible, but only 13.6% said that their child was too ill to be seen anywhere else (n = 60). Demographic differences occurred in the proportions of respondents citing some of the primary and secondary reasons for bringing their child to the ED. This study highlights 3 key findings. An immediate desire for care plays a key role in caregiver decision making for low-acuity visits. There is potential socioeconomic and racial bias in where care is recommended that needs to be further explored in this region. Cross community interventions that target key reasons for seeking low-acuity care have the highest likelihood of impacting the use of the ED for low-acuity conditions.

Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.

Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. Ecological study. We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.

Patient's Perspective for their Non-Urgent Presentations to the Emergency Department in Najran City

Aim of Study: To explore patients’ perspectives regarding the reasons why some less urgent, or non-urgent patients prefer to attend emergency departments (EDs) instead of using other more appropriate healthcare services. Methods: This study followed a quantitative cross-sectional design. The study obtained and analyzed emergency attendance data from King Khalid Hospital, Najran City. A study questionnaire was designed by the researcher to interview 400 ED patients, who inappropriately attended the ED, to identify the reasons for their inappropriate attendance to the ED. Data collection was performed during the period of two months (November-December, 2022) to explore the proportions of different attendances that were deemed inappropriate according to the hospital’s followed triage system. The interviews were conducted with the non-urgent and less urgent patients during their waiting times. Results: The age of 18.3% of patients were &lt;30 years old, while 28.5% were 30-39 years old. More than half of the participants’ visits were non-urgent, while 43.25% were less-urgent, 55.3% of patients visited the ED before due to similar complaints, and 46% visited a primary health care center before their ED visits. The main reasons for visiting the ED instead of the primary healthcare center (PHCC) were to save time (49.3%) and to get an earlier appointment (48%). Patients’ triage levels differed significantly according to their age groups (p&lt;0.001), nationality (p=0.022), educational level (p=0.022), marital status (p=0.002), ED visits due to similar complaints (p&lt;0.001), and previously visiting the PHCC for the current health problem (p=0.002). Triage levels also differed significantly according to some reasons for choosing to go to the ED instead of the PHCC, especially to get an earlier appointment (p=0.044), preferring the healthcare services provided by the ED (p=0.005), having a nearby ED (p=0.001), or being at the hospital at that time (p=0.002). Conclusions: There is a clear relationship between inappropriate ED visits and certain associated factors, indicating that prevention would be best targeted to certain categories, such as Saudi, younger, and educated patients. The main reasons for inappropriate ED visits are to save time and to avoid getting a late appointment. Recommendations: This study emphasized the importance of implementing proper health education and redirecting patients with inappropriate ED visits. Conducting a detailed analysis of the shortages in the utilization of primary healthcare resources is a pressing necessity. Further nationwide studies on patients’ perspective for non-urgent ED presentations are largely needed. Key Words: Emergency Department, Triage, Quantitative Research, Najran City, Saudi Arabia

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.

Community paramedicine in Central Oregon: A promising model to reduce non-urgent emergency department utilization among medically complex Medicaid beneficiaries.

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non-urgent care was measured by emergency medicine ED visits and avoidable ED visits. The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76-0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44-0.84) or 2.3 visits saved for every 100 people. Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home-based setting.

Nonurgent Emergency Department Use Among Women Sentenced to Probation.

Like women who are incarcerated, women sentenced to probation have high levels of physical and mental health morbidities. They rely heavily on hospital emergency departments (EDs) for health care in community settings. We examined the prevalence of nonurgent ED use in a cohort of women with a history of probation system involvement in Alameda County, California. We found that two-thirds of ED visits were nonurgent, even though most women had health insurance. Factors associated with nonurgent ED use included having one or more chronic health conditions, severe substance use, low health literacy, and recent arrest. Among a subgroup of women who also received primary care, dissatisfaction with a recent primary care visit was also associated with nonurgent ED use. The heavy use of the ED for nonurgent care in this study may reflect a need to provide options better attuned to the multiple forms of instability and barriers to wellness faced by women with criminal legal system involvement.

Evaluation of a transitions clinic to bridge emergency department and primary care.

Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. Retrospective cross-sectional study. This study included adults 18 years and older discharged from the ED and reeferred to the CTC. Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.

The Definition of Non-Urgent Visits to the Emergency Department and Validation of Criteria for Referrals

Background: The centers of disease control and prevention define a non-urgent Emergency Department (NU-ED) visit as a medical condition requiring treatment within more than 24 hours. These visits constitute one of the main reasons for emergency department (ED) overcrowding, which greatly affects healthcare workers’ wellbeing, health costs, patients’ satisfaction and treatment outcomes. Currently, there is no solid definition of non-urgent emergency visits, which is the first step towards dealing and potentially solving this issue. Having that, the aim of the current study is to define and validate the criteria for NU-ED visits in Israel. Methods: This qualitative study included twelve senior physicians and nurses working in Emergency Department and/or Health Maintenance Organizations (HMOs) across Israel. The study was performed using in-depth, semi-structured, open-ended interviews. Qualitative data analysis was performed by conventional content analysis. Results: The urgency of medical visits was defined based on these two questions: 1) Does the medical condition require an immediate treatment? 2) Is the emergency department the only place that can provide the required treatment at a certain timepoint? We found that non-urgent visits mostly occur during the nights and weekends, when medical treatments are not available in the HMOs. Visitors for non-urgent cases mostly complained about minor injuries or chronic conditions, fever, abdominal or chest pain. Most visits occurred based on referral from the family physician or the nurse from the call center. Participants reported a lack of awareness and knowledge about the roles of the EDs and the available options in the HMOs, which seem unable to provide patients with appropriate treatments. The usage of triage scales seems to ensure that patients are being treated based on the clinical urgency of their condition. Medical cases that score above 3 can be defined as non-urgent visits. Therefore, implementation of these scales in the community and their use in decision making of referrals to emergency department might greatly reduce non-urgent visits. Conclusions: Participants defined urgent ED visits as medical situations that need to be treated immediately, while there are no available treatment options in the HMOs. Participants identified many reasons behind NU referrals to the ED, mainly, low awareness about the role of ED, low availability of certain tests in the HMOs, and inability to provide adequate treatment in the community.