Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 140 No. 4142 (2010)

Referral practice among Swiss and non-Swiss walk-in patients in an urban surgical emergency department: Are there lessons to be learnt?

  • N Clement
  • A Businger
  • L Martinolli
  • AK Exadaktylos
DOI
https://doi.org/10.4414/smw.2010.13089
Cite this as:
Swiss Med Wkly. 2010;140:w13089
Published
11.10.2010

Summary

AIM: To assess the relationship between nationality, gender and age and use of health services among patients visiting an urban university hospital emergency department (ED).

INTRODUCTION: ED crowding is an increasingly significant national and international problem. Overcrowding has many potential detrimental effects, including frustration for patients and ED personnel and greater risk of poor outcomes. This is partially caused by the growing numbers of visits by so called “walk-in patients” with minor problems.

METHODS: From May 1, 2007 to May 31, 2008, sociodemographic information was collected prospectively from 6955 male and 4303 female patients at Inselspital, University Hospital Bern, Switzerland, who had requested our emergency services for non-urgent problems. A stratified sample of 1173 patients was taken for further analysis of referral by a general practitioner (GP) and having a GP at all.

RESULTS: In all, 26% of visits were by foreign nationals. Only 57% of these were registered with a GP, compared to 83% of Swiss nationals (p <0.0001). Swiss patients referred themselves to us in 87%, compared to 97% self-referrals among foreigners (p <0.0001). Between 7:00 pm and 7:00 am, our ED was significantly more often visited by non-Swiss patients (p <0.0001). Foreign patients were significantly younger than Swiss patients (median age 45, range 1–98 years versus age 35, range 2–89 years, p <0.0001).

CONCLUSION: Nationality is associated with greater use of ED services for non-urgent problems. Several explanations are conceivable for this. Clinical and policy efforts must address barriers to GP care, since in the long term the GP provides better and more cost-effective care for patients with minor complaints.

References

  1. Bianco A, Pileggi C, Angelillo IF. Non-urgent visits to a hospital emergency department in Italy. Public Health. 2003;117:250–5.
  2. Lang T, Davido A, Diakite B, Agay E, Viel JF, Flicoteaux B. Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect? J Epidemiol Community Health. 1996;50:456–62.
  3. Agouridakis P, Hatzakis K, Chatzimichali K, Psaromichalaki M, Askitopoulou H. Workload and case-mix in a Greek emergency department. Eur J Emerg Med. 2004;11:81–5.
  4. Wallis LA, Twomey M. Workload and case mix in Cape Town emergency departments. S Afr Med J. 2007;97:1276–80.
  5. Oktay C, Cete Y, Eray O, Pekdemir M, Gunerli A. Appropriateness of emergency department visits in a Turkish university hospital. Croat Med J. 2003;44(5):585–91.
  6. Pines JM, Iyer S, Disbot M, Hollander JE, Shofer FS, Datner EM. The effect of emergency department crowding on patient satisfaction for admitted patients. Acad Emerg Med. 2008;15(9):825–31.
  7. Krochmal P, Riley TA. Increased health care costs associated with ED overcrowding. Am J Emerg Med. 1994;12(3):265–6.
  8. Campell MK, Silver RW, Hoch J, Ostbye T, Stewart M, Barnsley J, et al. Re-utilization outcomes and costs of minor acute illness treated at family physician offices, walk-in clinics, and emergency departements. Can Fam Physician. 2005;51:82–3.
  9. Sprivulis PC, Da Silva JA, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184(5):208–12.
  10. Saxer T, Duperrex O, Vermeulen B, Vu Nu V. Emergency medicine training: a prospective, comparative study of an undergraduate clinical clerkship and army program. Swiss Med Wkly. 2009;139(29–30):423–9.
  11. Lang T, Davido A, Diakite B, Agay E, Viel JF, Flicoteaux B. Using the hospital emergency department as a regular source of care. Eur J Epidemiol. 1997;13:223–8.
  12. Backman AS, Blomqvist P, Lagerlund M, Carlsson-Holm E, Adami J. Characteristics of non-urgent patients. Scand J Prim Health Care. 2008;26:181– 7
  13. Exadaktylos AK, Evangelopoulos DS, Wullschleger M, Bürki L, Zimmermann H. Strategic emergency department design: An approach to capacity planning in healthcare provision in overcrowded emergency rooms. Journal of Trauma Management & Outcomes. 2008;2:11.
  14. Mackway-Jones K. Emergency triage. London: BMJ Publishing. 1997.
  15. Ausländerinnen und Ausländer in der Schweiz, Bericht 2008. Bundesamt für Statistik, Eidgenössisches Departement des Inneren, Schweizerische Eidgenossenschaft 2008. http://www.bfs.admin.ch/bfs/portal/de/index/news/publikationen.html?publicationID=3403 (last access 05.27.2010) Ausländische Wohnbevölkerung nach Heimatstaat und Bewilligungsart Ende 2009. Statistikdienste der Stadt Bern, Schweiz 2009. http://www.bern.ch/leben_in_bern/stadt/statistik/bevoelkerung/jaehrlich/2110bevauslnatiobew.pdf (last access 05.27.2010)
  16. Berger JT. The influence of physicians’ demographic characteristics and their patients’ demographic characteristics on physician practice: implications for education and research. Acad Med. 2008;83(1):100–5.
  17. Mehrota A, Liu H, Adams J, Wang MC, Lave J, Thygeson M, et al. The cost and quality of care for three common illnesses at retail clinics compared to other medical settings. Ann Intern Med. 2009;151(5):321–8.
  18. De Maeseneer JM, De Prins L, Gosset C, Heyerick J. Provider continuity in family medicine: does it make a difference for total health care costs? Ann Fam Med. 2003;1:144–8.
  19. Alazri MH, Neal RD. The association between satisfaction with services provided in primary care and outcomes in Type 2 diabetes mellitus. Diabetic Medicine. 2003;20:486–90.
  20. Fan VS, Burman M, McDonell MB, Fihn SD. Continuity of care and other determinants of patient satisfaction with primary care. J Gen Intern Med. 2005;20:226–33.
  21. Junot Perron N, Favrat B, Vannotti M. Patients who attend a private practice vs a university outpatient clinic: how do they differ? Swiss Med Wkly. 2004;134:730–7.
  22. Althaus F, Paroz S, Renteria SC, Rossi I, Gehri M, Bodenmann P. Gesundheit von Ausländern in der Schweiz. Swiss Med Forum. 2010;10(4):59–64.