Emergency Room Use Research Articles

What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.

Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploits the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. Randomization in the trial is used as an instrumental variable for family involvement in care, resulting in a causal estimate of the effect of changing the combination of home health-care providers on health-care utilization and health outcomes of the beneficiary. We find that some family involvement in home-based care significantly decreases health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use. We find that individuals who have some family involved in home-based care are less likely to have several adverse health outcomes within the first 9months of the trial, including lower prevalence of infections, bedsores, or shortness of breath, suggesting that the lower utilization may be due to better health outcomes.

Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France

Changes in asthma care need to be documented at arrival of biotherapies. To characterize changes in asthma care and outcomes in patients with persistent asthma. Repeated transversal analyses were conducted on a historical cohort using the French national claims data over 10 years. Patients aged 18 to 40 years with either 1 or more (any-use population) or 4 or more (high-use population) yearly dispensings of controller therapy were selected. Clinical and demographic features were characterized, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, health care resource utilization, and outcomes. In 2016, prevalent use of controller therapy was 5.2% (any-use population) and 0.8% (high-use population) of the population aged 18 to 40 years. In the any-use population, the use of long-acting β2-agonists in monotherapy, and inhaled corticosteroids decreased (1.7% and 40.3% in 2016, respectively), whereas the use of fixed-dose combinations increased (56.4%). In both populations, visits to respiratory or hospital physicians and pulmonary function testing increased with time, in parallel to a decreasing number of general practitioner visits; in addition, oral corticosteroid use and incidence of emergency room visits increased. However, asthma hospitalizations and mortality remained low in both populations. Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β2-agonists as a monotherapy, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids and incidence of emergency room visits have increased over the last decade.

Emergency Room Use of “Fast-Track” Ultrasound in Acute Stroke: An Observational Study

Early information on vascular status in acute stroke is essential. We analyzed whether duplex ultrasound (DUS) using a fast-track protocol provides this information without relevant delay. One hundred forty-six patients were prospectively enrolled. DUS was performed by sonographers with two levels of experience. The carotid and vertebral arteries, as well as all basal cerebral arteries, were bilaterally analyzed. Criteria for vessel analysis were (i) normal or stenosis <50%, (ii) stenosis ≥50% and (iii) occlusion. The mean duration of the ultrasound investigation was 6:07 ± 2:06 min with a significant difference between more and less experienced investigators (p < 0.0001). Insonation times decreased during the study in both groups. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasound findings in comparison with computed tomography angiography were 73%, 99%, 84% and 98%, respectively. Our data suggest that “fast track” DUS is feasible and reliable. The time required for DUS assessment depends on the sonographer´s experience.

Health, Health Behaviors, and Health Care Utilization Among Adults with Serious Psychological Distress Who Receive Federal Housing Assistance.

Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey (NHIS) data, this study estimates the prevalence of serious psychological distress (SPD) among non-elderly HUD-assisted adults and examines differences in health, health behaviors, and health care utilization for this population. The linked data estimate that 13% of HUD-assisted adults experience SPD. Controlling for individual characteristics and HUD program type, assisted housing residents who had SPD experienced higher rates of self-reported fair or poor health, chronic disease, and cigarette smoking than HUD-assisted adults without SPD. Adults with SPD had more frequent use of emergency rooms and were more likely than residents without SPD to have more frequent contact with specialists, general doctors, and mental health providers, although they also reported increased levels of unmet health care needs due to affordability. Policy implications are discussed.

Assessing quality indicators related to mental health emergency room utilization

BackgroundThis descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI).MethodsData emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06.ResultsPMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low.ConclusionsThis study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.

Building a Common Voice Corpus for Laiholh (Hakha Chin)

In this paper, we discuss our efforts to build a corpus for Laiholh, also called Hakha Chin. Laiholh is spoken in Chin State in Western Myanmar, in parts of India and Bangladesh, and in several Burmese refugee communities in the US. Indiana, for example, is home to about 25,000 Burmese refugees. The ultimate goal of our team is to contribute to the development of speech translation technology that will be of benefit, both in general and in the local community in Indianapolis. Translation tools would be of great use in local emergency rooms, schools, and businesses. In pursuing our (admittedly lofty) goals, we are building a growing community of speakers, field linguists, computational linguists, and computer scientists. As a team, we have worked to share our different skill sets and mobilize the wider community around collecting data via Mozilla’s Common Voice platform. We present here a reflection on the project thus far, the kind of description we wish had existed when we were first building this collaboration and determining preliminary project goals. We hope that other communities and language activists who are thinking about developing speech technology may benefit from hearing about our motivations, concerns, experiences, and successes.

POOR HOUSING AND POOR ACCESS TO SERVICES: IS THERE AN ASSOCIATION?

We completed a series of analyses asking if the need for home repair is associated with negative health related outcomes. Using an omnibus health survey of Philadelphia and the four surrounding counties conducted in 2015, we restricted our analyses to those persons age 60 and older who reported that they rented their homes (n=570). We discovered a statistically significant relation between need for home repair and the need for 1) access to meals and 2) access to prescription program. A significant relation was also identified between need for repair and poorer mental health and functional health as well as more frequent use of emergency rooms. We conclude that need for repair is part of a constellation of challenges to maintaining health for older adults and the home environment must be included in any comprehensive assessment of health status even for those persons living in public housing and similar settings.

Living Well: An Intervention to Improve Medical Illness Self-Management Among Individuals With Serious Mental Illness.

Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions. Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes. Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up. Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.

Marijuana use by middle-aged and older adults in the United States, 2015–2016

BackgroundMarijuana use is increasing among middle-aged and older adults in the US, but little is understood of its pattern of use by this population. MethodsWe performed a cross-sectional analysis of responses from 17,608 adults aged ≥50 years from the 2015 and 2016 administrations of the National Survey on Drug Use and Health. Prevalence of past-year marijuana use was estimated and compared between middle-aged adults (age 50–64) and older adults (≥65). Characteristics of past-year marijuana users including demographics, substance use, chronic disease, and emergency room use, were compared to non-marijuana users and stratified by age group. Marijuana use characteristics were also compared between middle-aged and older adults. We used multivariable logistic regression to determine correlates of past-year marijuana use. ResultsPrevalence of past-year marijuana use was 9.0% among adults aged 50–64 and 2.9% among adults aged ≥65. Prevalence of past-year alcohol use disorder (AUD), nicotine dependence, cocaine use, and misuse of prescription medications (i.e., opioids, sedatives, tranquilizers) were higher among marijuana users compared to non-users. In adjusted models, initiation of marijuana use <19 years of age [adjusted odds ratio (AOR) = 13.43, 95% confidence interval (CI) 9.60, 18.78)], AUD (AOR = 2.11, 95% CI 1.51, 2.94), prescription opioid misuse (AOR 2.49, 95% CI 1.61, 3.85), nicotine dependence (AOR = 1.90, 95% CI 1.59, 2.26), and cocaine use (AOR 7.43, 95% CI 4.23, 13.03), were all associated with increased odds of past-year marijuana use. ConclusionMarijuana use is becoming more prevalent in this population and users are also at high risk for other drug use.

Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators.

This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.

Impacts of a Two-Part Multidisciplinary Diabetes Education Program on Glycemic Control and Hospital Use

Background: Emergency room and hospital use remain high among those with diabetes. Interventions need to be developed to reduce the utilization of this high-cost care while still improving diabetes management. Purpose: To analyze changes in outcomes for patient with diabetes who attend a two-part multidisciplinary diabetes education program, which includes a 1-day DSME class and a ½ day “Speed Dating” session in terms of ER and hospital use, A1C, and LDL-cholesterol from January 2016-2018. Method: Adult patients with diabetes at a family medicine clinic are enrolled and attend an 8-hour DSME class followed by a 3-hour multidisciplinary clinic 2 weeks later during which patients rotate every 30 min through 5 centers hosted by a 1) family medicine physician, 2) clinical pharmacist (CDE), 3) nurse or dietician (CDE), 4) case manager, and 5) clinical psychologist to address and improve care. Data was systematically extracted from the electronic medical record (EMR) 6 months before, 6 and 12 months after attending the class to determine impact of the program. Paired t-tests determined significance between baseline and post-intervention measures. Results: Over 24 months, 22 adults attended the program. At baseline patients had an average A1C of 10.2% and LDL of 115 mg/dL. Six months before attending the class they presented to the ER 0.68 times, were admitted to the hospital 0.5 times, and when admitted, had an average length of stay (LOS) of 5.3 days. After attending the program patients’ A1C declined to 9.1% at 6 months (p=0.28) and 8.7% at 12 months (p=0.022). Their LDL-C declined to 110 mg/dl (p = 0.71). Although ER use increased to 0.8, their hospital admission rate and LOS decreased to 0.36 and 3.3 days respectively per patient. Implications: Incorporation of the DSME plus Speed Dating program improved care by lower A1C by 1.5%, hospital admission rate by 0.14, and LOS by 2 days over a 6-month window. Ultimately these improvements additionally lower healthcare costs. Disclosure H.P.Q. Whitley: None.A. Stallworth: None.D. Desai: None.C. Hanson: None.

Low Rates of Dermatologic Care and Skin Cancer Screening Among Inflammatory Bowel Disease Patients.

Dermatologic manifestations of inflammatory bowel disease (IBD) are common, and certain IBD medications increase the risk of skin cancer. To define the rates of care and factors associated with dermatologic utilization with a focus on skin cancer screening. We utilized a prospective, natural history IBD research registry to evaluate all outpatient healthcare encounters from 2010 to 2016. Gastrointestinal, dermatologic and primary care visits per individual were identified. We calculated the proportion of patients obtaining care, categorized primary indications for dermatologic visits, determined the incidence of melanoma and non-melanoma skin cancers, and used logistic regression to determine factors associated with dermatology utilization. Of the 2127 IBD patients included, 452 (21.3%) utilized dermatology over the study period, and 55 (2.6%) had a total body skin examination at least once. The 452 patients incurred 1633 dermatology clinic visits, 278 dermatologic procedures, and 1108 dermatology telephone encounters. The most frequent indication was contact dermatitis or dermatitis. Factors associated with dermatology use were family history of skin cancer, employment, systemic steroids, longer disease duration, emergency room use, and the number of IBD-related clinic visits. Between 8.3 and 11% of IBD patients recommended for skin cancer screening visited dermatology each year, and the resulting incidence of non-melanoma skin cancer was 35.4/10,000 [95% CI 23.3-51.5] and melanoma was 6.56/10,000 [95% CI 2.1-15.3]. Less than one in ten IBD patients obtain dermatologic care. Given the increased risk of skin cancers among IBD patients, an emphasis on education, prevention, and screening merits attention.

Healthcare Utilization after Acute Kidney Injury in the Pediatric Intensive Care Unit.

Little is known about the long-term burden of AKI in the pediatric intensive care unit. We aim to evaluate if pediatric AKI is associated with higher health service use post-hospital discharge. This is a retrospective cohort study of children (≤18 years old) admitted to two tertiary centers in Montreal, Canada. Only the first admission per patient was included. AKI was defined in two ways: serum creatinine alone or serum creatinine and/or urine output. The outcomes were 30-day, 1-year, and 5-year hospitalizations, emergency room visits, and physician visits per person-time using provincial administrative data. Univariable and multivariable Poisson regression were used to evaluate AKI associations with outcomes. A total of 2041 children were included (56% male, mean admission age 6.5±5.8 years); 299 of 1575 (19%) developed AKI defined using serum creatinine alone, and when urine output was included in the AKI definition 355 of 1622 (22%) children developed AKI. AKI defined using serum creatinine alone and AKI defined using serum creatinine and urine output were both associated with higher 1- and 5-year hospitalization risk (AKI by serum creatinine alone adjusted relative risk, 1.42; 95% confidence interval, 1.12 to 1.82; and 1.80; 1.54 to 2.11, respectively [similar when urine output was included]) and higher 5-year physician visits (adjusted relative risk, 1.26; 95% confidence interval, 1.14 to 1.39). AKI was not associated with emergency room use after adjustments. AKI is independently associated with higher hospitalizations and physician visits postdischarge.

Three-Year Results of a Medicare Advantage Cancer Management Program.

Reform of cancer care delivery seeks to control costs while improving quality. Texas Oncology collaborated with Aetna to conduct a payer-sponsored program that used evidence-based treatment pathways, a disease management call center, and an introduction to advance care planning to improve patient care and reduce total costs. From June 1, 2013, to May 31, 2016, 746 Medicare Advantage patients with nine common cancer diagnoses were enrolled. Patients electing for patient support services were telephoned by oncology nurses who assessed symptoms and quality of life and introduced advance care planning. Shared cost savings were determined by comparing the costs of drugs, hospitalization, and emergency room use for 509 eligible patients in the study group with a matched cohort of 900 Medicare Advantage patients treated by non-Texas Oncology providers. Physician adherence to treatment pathways and performance and quality metrics were evaluated. During the 3 years of the study, the cumulative cost savings were $3,033,248, and savings continued to increase each year. Drug cost savings per patient per treatment month were $1,874 (95% CI, $1,373 to $2,376; P < .001) after adjusting for age, diagnosis, and study year. Solid tumors contributed most of the savings; hematologic cancers showed little savings. For years 1, 2, and 3, adherence to treatment pathways was 81%, 84%, and 90%, patient satisfaction with patient support services was 94%, 93%, and 94%, and hospice enrollment was 55%, 57%, and 64%, respectively. A practice-based program supported by a payer sponsor can reduce costs while maintaining high adherence to treatment pathways and patient satisfaction in older patients.

Validation of the What Matters Index: A brief, patient-reported index that guides care for chronic conditions and can substitute for computer-generated risk models.

IntroductionCurrent health care delivery relies on complex, computer-generated risk models constructed from insurance claims and medical record data. However, these models produce inaccurate predictions of risk levels for individual patients, do not explicitly guide care, and undermine health management investments in many patients at lesser risk. Therefore, this study prospectively validates a concise patient-reported risk assessment that addresses these inadequacies of computer-generated risk models.MethodsFive measures with well-documented impacts on the use of health services are summed to create a “What Matters Index.” These measures are: 1) insufficient confidence to self-manage health problems, 2) pain, 3) bothersome emotions, 4) polypharmacy, and 5) adverse medication effects. We compare the sensitivity and predictive values of this index with two representative risk models in a population of 8619 Medicaid recipients.ResultsThe patient-reported “What Matters Index” and the conventional risk models are found to exhibit similar sensitivities and predictive values for subsequent hospital or emergency room use. The “What Matters Index” is also reliable: akin to its performance during development, for patients with index scores of 1, 2, and ≥3, the odds ratios (with 95% confidence intervals) for subsequent hospitalization within 1 year, relative to patients with a score of 0, are 1.3 (1.1–1.6), 2.0 (1.6–2.4), and 3.4 (2.9–4.0), respectively; for emergency room use, the corresponding odds ratios are 1.3 (1.1–1.4), 1.9 (1.6–2.1), and 2.9 (2.6–3.3). Similar findings were replicated among smaller populations of 1061 mostly older patients from nine private practices and 4428 Medicaid patients without chronic conditions.SummaryIn contrast to complex computer-generated risk models, the brief patient-reported “What Matters Index” immediately and unambiguously identifies fundamental, remediable needs for each patient and more sensibly directs the delivery of services to patient categories based on their risk for subsequent costly care.

Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients.

Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.

Nurse practitioner independence, health care utilization, and health outcomes

Many states allow nurse practitioners (NPs) to practice and prescribe drugs without physician oversight, increasing the number of autonomous primary care providers. We estimate the causal impact of NP independence on population health care utilization rates and health outcomes, exploiting variation in the timing of state law passage. We find that NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulatory care sensitive conditions. These effects come from decreases in administrative costs for physicians and NPs and patients’ indirect costs of accessing medical care.

P236 Symptoms of anxiety and depression in inflammatory bowel disease

Treatment of Crohn’s disease (CD) and ulcerative colitis (UC) is usually directed at organic aspects of the disease, often disregarding psychosocial factors. A comprehensive strategy including identification of anxiety and depression are possible therapeutic targets to increase quality of life in inflammatory bowel disease (IBD). The present study aims to test the association between anxious and depressive symptoms with IBD activity and course. Of 221 patients followed in outpatient setting in October and November of 2017, 64 patients with confirmed IBD who accepted to participate in the study were selected. Patients with known mental illness followed by Psychiatry were excluded. Anxiety symptoms were quantified by Spielberg's Anxious State Inventory (STAI) and symptoms of depression by the Beck II Depression Scale (BDI-II). Sixty-four patients were included, of which 75% with CD and 25% with UC. The mean age was 40 ± 13.99 years and 53.1% were female. Clinical remission rate was 87.5% in CU and 75% in CD, with an endoscopic remission rate of 25% in CU and 50% in CD. The correlation between anxiety and depression symptoms was significant (p <0.001, r = 0.73). There was no statistically significant difference in anxiety and depression scores between patients with CD and CU. The correlation of number of disease flairs with STAI and BDI-II scores was significant (STAI p = 0.023; BDI-II p = 0.017). In IBD patients, there was also a statistically significant association between STAI score (anxiety) and clinical remission, endoscopic remission and need for therapy step-up (p <0.05). In CD patients there was a significant association between anxiety and the presence of perianal disease (p = 0.035). In UC patients, there was a significant association between anxiety and recent flair (p = 0.021), use of emergency room (p = 0.029), hospitalisation (p = 0.029) and therapy step-up (p = 0.013). In this group of patients a significant association between depressive symptoms and immunosuppressant or anti-TNF therapy was seen (p = 0.009). In the analysed patients there was an association of anxious and/or depressive symptoms with frequency of disease flairs and disease activity. Screening for anxious and depressive symptoms may have a significant impact on the quality of life of patients with IBD.

Transitions in Care from Pediatric to Adult Health Care Providers: Ongoing Challenges and Opportunities for Young Persons with Diabetes.

Adolescence and young adulthood are times of multiple developmental changes, including physiological, social, emotional, cognitive, and behavioral transformations. The adolescent or young adult living with type 1 or type 2 diabetes must navigate the vicissitudes of these developmental stages while managing the rigors and self-care demands of these conditions. Diabetes in children is managed by adults, mainly by parents. As the child matures, diabetes management tasks transition from parents to the developing teen. This transition in care is a process that generally begins in early adolescence and culminates when the older teen successfully accepts and manages diabetes self-care tasks. Along with the transitions in diabetes management tasks, older teens and young adults must be prepared for transfer from the pediatric diabetes care team to an adult-focused health care team. Numerous publications have described the challenges associated with both the process of transition and the act of transfer. Lack of preparation during transition followed by unsuccessful transfer often results in gaps in diabetes care exceeding 6 months, deterioration in glycemic control, increase in emergency room use and hospitalization, and emergence of diabetes complications among older teens and young adults. There is need for ongoing research internationally to address these deficiencies in order to improve the short- and long-term health of young persons with diabetes.

Evaluation of the use of Home Emergency in a Sub-Sahara African hospital: Example of the Hospital Principal in Dakar.

Overloaded emergency departments are common around the world. This prospective, descriptive, and analytical study evaluates the reasons for emergency room use and describes the severity of the patients' conditions and how they reach the emergency department. It took place at the emergency department of the principal hospital of Dakar (the Armed Forces Teaching Hospital) over a one-week period (from August 23 to August 30, 2016) and included a sample of 219 patients of both sexes aged 15 years and older. Data were collected about social and demographic characteristics, reasons for choosing the emergency department rather than other care, time of day, day of the week, accessibility, means of transport, diagnosis, and severity. More than half of patients (55%) were men, with a mean age of 42 +/- 18. Only 10% of patients lived within 5km of the hospital. Most (84.5%) came from the Dakar region and lived between 5 and 35km from the hospital. Most patients reached the hospital by their own means (83%). Only 2% were transported by the public emergency ambulance service. The reasons for choosing the emergency unit were the opportunity for additional tests in 41.1% of cases; the desire to be hospitalized in 26.9%; fear of death in 26.5%, no waiting list in 14.2%, and lack of money in 11% of cases. Patients in truly serious condition accounted for only 5% of cases. Most (88%) returned home after stabilization, 12% were hospitalized, and 0.5% died. Good practices, good organization, and improved complementarity between public, private, and emergency services are needed to reduce the use of the latter.