Vol. 145 No. 1516 (2015)
Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital
- Léonard Diserens
- Lukas Egli
- Sarah Fustinoni
- Brigitte Santos-Eggimann
- Philippe Staeger
- Olivier Hugli
INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients’ characteristics and reasons for consultation had changed over 13 years.
METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP).
RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p = 0.128). Of these patients, 54.0% vs 57.0% were male (p = 0.329), 55.5% vs 58.7% were Swiss (p = 0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p <0.001); 57.7% vs., 58.3% consulted during out-of- hours (p = 0.821). Trauma-related visits decreased from 34.2% to 23.7% (p <0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p <0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP’s treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p <0.001).
CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.
- Guntensperger U, Pinzello-Hurlimann R, Martina B, Ciurea A, Muff B, Gutzwiller JP. Primary care emergency services utilization in German-speaking Switzerland: a population-based cross-sectional study. Swiss Med Wkly. 2010;140:w13111.
- Pitts SR, Carrier ER, Rich EC, Kellermann AL. Where Americans get acute care: increasingly, it’s not at their doctor’s office. Health Aff (Millwood). 2010;29:1620–9.
- Chmiel C, Huber CA, Rosemann T, Zoller M, Eichler K, Sidler P, et al. Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison. BMC Health Serv Res. 2011;11:94.
- Vilpert S. Consultations dans un service d’urgence en Suisse. Neuchâtel: Observatoire suisse de la santé, 2013 Report No. 3/2013. French/German.
- Bonvicini L, Broccoli S, D'Angelo S, Candela S. Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians. Epidemiol Prev. 2011;35:259–66.
- George G, Jell C, Todd BS. Effect of population ageing on emergency department speed and efficiency: a historical perspective from a district general hospital in the UK. Emerg Med J. 2006;23:379–83.
- Gindi RM, Cohen RA, Kirzinger WK. Emergency Room Use Among Adults Aged 18–64: Early Release of Estimates From the National Health Interview Survey, January–June 2011. National Center for Health Statistics May 2012. Available from: http://www.cdc.gov/nchs/nhis/releases.htm.
- Hargreaves S, Friedland JS, Gothard P, Saxena S, Millington H, Eliahoo J, et al. Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders. BMC Health Serv Res. 2006;6:153.
- Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care. 2013;19:47–59.
- Eichler K, Hess S, Chmiel C, Bogli K, Sidler P, Senn O, et al. Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study. Emerg Med J. 2014;31:818–23.
- Sanchez B, Hirzel AH, Bingisser R, Ciurea A, Exadaktylos A, Lehmann B, et al. State of Emergency Medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6:23.
- Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52:126–36.
- McCusker J, Vadeboncoeur A, Levesque JF, Ciampi A, Belzile E. Increases in Emergency Department Occupancy Are Associated With Adverse 30–day Outcomes. Acad Emerg Med. 2014;21:1092–100.
- Rathlev NK, Chessare J, Olshaker J, Obendorfer D, Mehta SD, Rothenhaus T, et al. Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med. 2007;49:265–71.
- Santos-Eggimann B, Halfon P. Analyse du recours au service des urgences du Centre Hospitalier Universitaire Vaudois. Lausanne: Centre Hospitalier Universitaire Vaudois, Insitut de Médecine Sociale et Préventive; 2000.
- Santos-Eggimann B. Increasing use of the emergency department in a Swiss hospital: observational study based on measures of the severity of cases. BMJ. 2002;324:1186–7.
- Rutschmann OT, Kossovsky M, Geissbuhler A, Perneger TV, Vermeulen B, Simon J, et al. Interactive triage simulator revealed important variability in both process and outcome of emergency triage. J Clin Epidemiol. 2006;59:615–21.
- Weiss M, Bernoulli L, Zollinger A. The NACA scale. Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients. Anaesthesist. 2001;50:150–4. German.
- FitzGerald G, Toloo S, Rego J, Ting J, Aitken P, Tippett V. Demand for public hospital emergency department services in Australia: 2000–2001 to 2009–2010. Emerg Med Australas. 2012;24:72–8.
- Chan CL, Lin W, Yang NP, Huang HT. The association between the availability of ambulatory care and non-emergency treatment in emergency medicine departments: a comprehensive and nationwide validation. Health Policy. 2013;110:271–9.
- Mason S, Mountain G, Turner J, Arain M, Revue E, Weber EJ. Innovations to reduce demand and crowding in emergency care; a review study. Scand J Trauma Resusc Emerg Med. 2014;22:55.
- Müller U, Winterhalder R, Businger A, Zimmermann H, Exadaktylos AK. Why do walk-in patients prefer a busy urban emergency department during office hours? A pilot survey of 200 consecutive patients from Switzerland. Swiss Med Wkly. 2012;142:w13565.
- Durand A-C, Palazzolo S, Tanti-Hardouin N, Gerbeaux P, Sambuc R, Gentile S. Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients. BMC Research Notes. 2012;5:525.
- Bardelli P, Kaplan V. Non-urgent encounters in a Swiss medical emergency unit. Swiss Med Wkly. 2013;143:w13760.
- de Valk J, Taal EM, Nijhoff MS, Harms MH, Lieshout EM, Patka P, et al. Self-referred patients at the Emergency Department: patient characteristics, motivations, and willingness to make a copayment. Int J Emerg Med. 2014;7:30.
- Moll van Charante EP, ter Riet G, Bindels P. Self-referrals to the A&E department during out-of-hours: patients' motives and characteristics. Patient Educ Couns. 2008;70:256–65.
- van der Linden MC, Lindeboom R, van der Linden N, van den Brand CL, Lam RC, Lucas C, et al. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral. Int J Emerg Med. 2014;7:28.
- DeVries A, Li CH, Oza M. Strategies to reduce nonurgent emergency department use: experience of a Northern Virginia Employer Group. Med Care. 2013;51:224–30.
- Sarver JH, Cydulka RK, Baker DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med. 2002;9:916–23.
- Huntley A, Lasserson D, Wye L, Morris R, Checkland K, England H, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ Open. 2014;4:e004746.
- Kocher KE, Asplin BR. What is our plan for acute unscheduled care? Ann Intern Med. 2013;158:907–9.
- La population de la Suisse 2012. Neuchâtel: Federal Statistical Office, 2013. Available from: http://www.bfs.admin.ch/bfs/portal/en/index/themen/01/22/publ.html?publicationID=5748
- Federal Statistical Office. Interactive Statistical Atlas of Switzerland [cited 30.10.2014]. Available from: http://www.atlas.bfs.admin.ch/maps/13/map/mapIdOnly/0_fr.html.
- Clément N, Businger A, Martinolli L, Zimmermann H, Exadaktylos AK. Referral practice among Swiss and non-Swiss walk-in patients in an urban surgical emergency department. Swiss Med Wkly. 2010;140:w13089.
- Buron A, Cots F, Garcia O, Vall O, Castells X. Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain. BMC Health Serv Res. 2008;8:51.
- Davidovitch N, Filc D, Novack L, Balicer RD. Immigrating to a universal health care system: utilization of hospital services by immigrants in Israel. Health Place. 2013;20:13–8.
- Tarraf W, Vega W, Gonzalez HM. Emergency department services use among immigrant and non-immigrant groups in the United States. J Immigr Minor Health. 2014;16:595–606.
- Rue M, Cabre X, Soler-Gonzalez J, Bosch A, Almirall M, Serna MC. Emergency hospital services utilization in Lleida (Spain): A cross-sectional study of immigrant and Spanish-born populations. BMC Health Serv Res. 2008;8:81.
- Zinelli M, Musetti V, Comelli I, Lippi G, Cervellin G. Emergency department utilization rates among immigrant population. A 5–year survey in a large Italian urban emergency department. Emerg Care J. 2014;10:1896.
- Jimenez-Rubio D, Hernandez-Quevedo C. Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences? Eur J Health Econ. 2011;12:17–28.
- Alyasin A, Douglas C. Reasons for non-urgent presentations to the emergency department in Saudi Arabia. Int Emerg Nurs. 2014;22:220–5.
- Rouzier S, Vardon D, Joly M, Latrie TDM, Boyeau-Desmarres C, Six P, et al. Analyse des déterminants du recours et des caractéristiques sociodémographiques des patients se présentant spontanément aux urgences sans avis médical préalable. Ann Fr Med Urg. 2014;4:143–52.