This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Patterns and Reasons for Use

Gary P. Young, MD; Michele B. Wagner, MD; Arthur L. Kellermann, MD, MPH; Jack Ellis, MD; Doug Bouley, RN; for the 24 Hours in the ED Study Group

JAMA. 1996;276(6):460-465.

Abstract
Objectives.
—To characterize the reasons ambulatory patients use hospital emergency departments (EDs) for outpatient care and to determine the proportion of ED patients who initially are assessed as having nonurgent conditions, but subsequently are hospitalized.

Design.
—Cross-sectional survey during a single 24-hour period of time.

Setting.
—Fifty-six hospital EDs nationwide.

Patients or Other Participants.
—Consecutive ambulatory patients presenting for care. Patients who arrived by ambulance were excluded.

Results.
—Of 6441 ambulatory patients (79% of all ED visits) who were eligible for study, interviews were obtained from 6187 (96%). A total of 5323 patients (86%) had clinical reasons or preferences for seeking care at an ED, including 2799 (45%) who thought they had an emergency or an urgent condition or were too sick to go elsewhere. Nineteen percent (n=1199) reported that they were sent to the ED by a health care professional. Patients with a regular clinician or with insurance cited similar reasons for seeking care at an ED. A total of 3062 patients (50%) cited 1 or more nonfinancial barriers to care as an important reason for coming to the ED, and 949 (15%) cited financial considerations. A total of 3045 patients (49% of ambulatory patients and 37% of total ED visits) were assessed at triage as having a nonurgent condition; 166 of them (5.5%; 95% confidence interval, 4.7%-6.3%) were admitted to the hospital.

Conclusions.
—Most ambulatory patients seek care in an ED because of worrisome symptoms or nonfinancial barriers to care. Although many ambulatory patients appear to have nonurgent conditions based on triage classification, a small but disturbing percentage of nonurgent patients are hospitalized.

Author Affiliations
From the Department of Emergency Medicine, Highland General Hospital, Oakland, Calif, and the University of California at San Francisco (Drs Young and Ellis and Mr Bouley); the Division of Emergency Medicine, Beth Israel Hospital, Boston, Mass (Dr Wagner); and the Division of Emergency Medicine, Department of Surgery, Emory University, Atlanta, Ga (Dr Kellermann).

Footnotes
A complete list of the 24 Hours in the ED Study Group investigators appears at the end of this article.

The views expressed are those of the authors and do not necessarily reflect those of the Society for Academic Emergency Medicine.

Reprints: Gary P. Young, MD, Department of Emergency Medicine, Highland Hospital, 1411 E 31st St, Oakland, CA 94602.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Uninsured Adults Presenting to US Emergency Departments: Assumptions vs Data
Newton et al.
JAMA 2008;300:1914-1924.
ABSTRACT | FULL TEXT  

Waits To See An Emergency Department Physician: U.S. Trends And Predictors, 1997-2004
Wilper et al.
Health Aff (Millwood) 2008;27:w84-w95.
ABSTRACT | FULL TEXT  

Quality of Primary Care and Subsequent Pediatric Emergency Department Utilization
Brousseau et al.
Pediatrics 2007;119:1131-1138.
ABSTRACT | FULL TEXT  

Overcrowding Crisis in Our Nation's Emergency Departments: Is Our Safety Net Unraveling?
Committee on Pediatric Emergency Medicine
Pediatrics 2004;114:878-888.
ABSTRACT | FULL TEXT  

TREADWELL ET AL. RESPOND
Treadwell et al.
AJPH 2004;94:907-908.
FULL TEXT  

INDIGENT MEN'S USE OF EMERGENCY DEPARTMENTS OVER PRIMARY CARE SETTINGS
Schanzer and Morgan
AJPH 2004;94:906-907.
FULL TEXT  

The Many Faces of Access: Reasons for Medically Nonurgent Emergency Department Visits
Guttman et al.
Journal of Health Politics, Policy and Law 2003;28:1089-1120.
ABSTRACT  

Deferred Care for Emergency Department Users with Nonacute Conditions
Washington et al.
ANN INTERN MED 2003;139:528-528.
FULL TEXT  

Deferred Care for Emergency Department Users with Nonacute Conditions
Kellermann
ANN INTERN MED 2003;139:526-528.
FULL TEXT  

Primary Care Medicine in Crisis: Toward Reconstruction and Renewal
Moore and Showstack
ANN INTERN MED 2003;138:244-247.
ABSTRACT | FULL TEXT  

Next-Day Care for Emergency Department Users with Nonacute Conditions: A Randomized, Controlled Trial
Washington et al.
ANN INTERN MED 2002;137:707-714.
ABSTRACT | FULL TEXT  

Relationship Between Early Primary Care and Emergency Department Use in Early Infancy by the Medicaid Population
Kotagal et al.
Arch Pediatr Adolesc Med 2002;156:710-716.
ABSTRACT | FULL TEXT  

Will alternative immediate care services reduce demands for non-urgent treatment at accident and emergency?
Coleman et al.
Emerg. Med. J. 2001;18:482-487.
ABSTRACT | FULL TEXT  

Factors Associated With Emergency Department Utilization for Nonurgent Pediatric Problems
Phelps et al.
Arch Fam Med 2000;9:1086-1092.
ABSTRACT | FULL TEXT  

WHICH PATIENTS DON'T REALLY NEED THE ED?
JWatch General 1996;1996:3-3.
FULL TEXT  

Triage of Ambulatory Patients
Adams and Fontanarosa
JAMA 1996;276:493-494.
ABSTRACT