Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group
G. P. Young, M. B. Wagner, A. L. Kellermann, J. Ellis and D. Bouley
Department of Emergency Medicine, Highland General Hospital, Oakland, CA 94602, USA.
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. Patents who arrived by ambulance were
excluded. RESULTS: Of 6441 ambulatory patients (79 percent of all ED
visits) who were eligible for study, interviews were obtained from 6187 (96
percent). A total of 5323 patients (86 percent) had clinical reasons or
preferences for seeking care at an ED, including 2799 (45 percent) 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 percent) cited 1 or more nonfinancial barriers to care as an
important reason for coming to the ED, and 949 (15 percent) cited financial
considerations. A total of 3045 patents (49 percent of ambulatory patients
and 37 percent of total ED visits) were assessed at triage as having a
nonurgent condition; 166 of them (5.5 percent; 95 percent confidence
interval, 4.7 percent-6.3 percent) 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.
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.
Am. J. Public Health 2004;94:907-908.
FULL TEXT
INDIGENT MEN'S USE OF EMERGENCY DEPARTMENTS OVER PRIMARY CARE SETTINGS
Schanzer and Morgan
Am. J. Public Health 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
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
