Inappropriate emergency department visits

doi:10.1016/S0196-0644(85)80886-6

Annals of Emergency Medicine

Volume 14, Issue 7, July 1985, Pages 672-676

https://doi.org/10.1016/S0196-0644(85)80886-6 Get rights and content

Guidelines adopted in 1982 by the American College of Emergency Physicians were used to determine appropriate and inappropriate emergency department (ED) utilization patterns at three community hospitals during a two-week period in August 1983. In all, 3,130 visits were examined. There was an overall inappropriate visit rate of 10.8%, although considerable variation was observed among the three hospitals. Subgroups with the highest inappropriate visit rates included the following: 1) persons with Medicaid as the primary payment source (17.3%); 2) children aged 5 years or younger (15.2%); 3) those unable to identify a personal physician (14.1%); 4) unemployed persons (13.1%); 5) patients making visits during regular office hours (12.6%); and 6) those failing to attempt to contact their personal physicians (12.4%). These variations in inappropriate usage were all statistically significant at the P < .05 level or better. Inability to identify a personal physician emerged as the most pervasive influence on inappropriate ED visit rates (P < .001).

References (12)

GiffordMJ et al.
Emergency physicians' and patients' assessments: Urgency of need for medical care
Ann Emerg Med
(1980)
Executive summary and comments
(October 23, 1982)
WeinermanER et al.
Yale studies in ambulatory medical care: Determinants of use of hospital emergency services
Am J Public Health
(1966)
VaydaE et al.
Emergency department use at two Hamilton hospitals
Can Med Assoc J
(1975)
WolcottBW
What is an emergency? Depends on whom you ask
JACEP
(1979)
StratmannWC et al.
A study of consumer attitudes about health care: The role of the emergency room
Med Care
(1975)

There are more references available in the full text version of this article.

Cited by (138)

Does the opening of an emergency department influence hospital admissions? Evidence from French private hospitals
2024, Social Science and Medicine
Although operating an emergency department (ED) can influence general admission activity of hospitals, most articles that analyze hospital care ignore the potential spillover of emergency activity. In this paper, we examine the consequences of a French reform that encouraged the creation of EDs within private-for-profit (PFP) hospitals in order to decrease congestion in EDs. We use administrative panel data on 365 French PFP hospitals observed between 2002 and 2012. Specifications including hospital fixed-effects are estimated to examine the impact of an ED opening on private hospitals’ admission activity, namely inpatient and day-care admissions (ED visits are excluded, but patients admitted following an ED visit are included). We control for shocks that can impact demand for care in hospitals, and we estimate yearly changes before and after the opening. We find that an ED opening is followed by an increase in the number and proportion of inpatient admissions, and by an increase in the length of inpatient stays. A transitory increase in the bed occupancy rate is also observed. In many countries, public and private hospitals compete to some extent. The former provide a public service, while the latter are profit-maximizers that are allowed to specialize in profitable activities. They generally focus on day-care admissions. We provide empirical evidence that private hospitals experience a significant change in the composition of their admissions when they start providing emergency care. Opening an ED creates a new non-selective entryway to private hospitals, resulting in admissions of inpatients with health problems that are more severe. Hence, involving PFP hospitals in the provision of emergency care is likely to make the structure of admissions of private hospitals closer to that of public hospitals.
Who are Clive's friends? Latent sociality in the emergency department
2020, Social Science and Medicine
In the absence of social services and robust social networks, staff working at social service institutions serve as a significant element of sociality in the lives of a segment of people experiencing homelessness. Relationships forged within these institutions prove to be avenues of emotional support and material resources that facilitate the survival of some homeless people. To illustrate this point, this article draws on data collected over the course of 18 months between July 2014 and December 2016. I present an ethnographic case study of an elderly homeless man, Clive, who was labeled a “super-utilizer” of an Emergency Department (ED) in Atlanta, Georgia. This article explores how Clive's relationships with ED staff transcended professional obligations and enabled his survival during his estrangement from friends and family. I demonstrate that the ED, and hospitals in general, are better understood as human infrastructures that perform functions in excess of providing biomedical services. This sociality, I argue, is key to understanding how the most vulnerable individuals survive in the context of increasing social abandonment.
Use of Emergency Departments for Preventative Care Among Adults in the United States: Estimates From the 2017 National Health Interview Survey
2019, Journal of Emergency Medicine
Citation Excerpt :
Findings from previous studies on associations between insurance and ED utilization have been mixed, with some studies indicating an association between nonurgent ED use among Medicare beneficiaries and the uninsured while other have indicated no association (15,30–33). While research has indicated higher rates of overall ED utilization among adults >65 years of age, our findings are consistent with studies suggesting that younger individuals account for a higher proportion of nonurgent ED visits (12–15,19,34). It has been hypothesized that factors such as unemployment, low-paying entry level jobs, or enrollment in education programs lacking adequate coverage options make it difficult for young adults to obtain affordable health insurance (35,36).
Use of the emergency department (ED) for routine or preventative care has been an abiding concern for policy makers and public health practitioners.
We utilized recent data to examine health-related, socioeconomic, and demographic factors associated with use of the ED for routine or preventative care using a national sample of adults.
Data from the 2017 National Health Interview Survey, a nationally representative sample of 26,742 adults ≥18 years of age was used for this investigation. Bivariate and multivariate analyses were used to assess the association between reported use of EDs as a usual source of preventative care and health-related, socioeconomic, and demographic factors.
In 2017, approximately 2 million adults nationwide reported the ED as their usual source of preventative health care. Individuals experiencing ≥2 health care–related barriers were more likely to use the ED as a source of usual preventative care (odds ratio = 2.78 [95% confidence interval 1.64–4.72]). Individuals without insurance had higher odds (odds ratio = 9.52 [95% confidence interval 5.60–16.19]) of using the ED for care compared with those who were privately insured. In addition, those using the ED for preventative care were more likely to be younger, poorer, less educated, to identify as Asian or African American, and to reside in the Northeast United States.
This study provides a current perspective into characteristics and factors contributing to use of the ED for preventative care. Overall, our findings suggest that the ED continues to provide crucial safety net services to a small subset of the population experiencing significant barriers to timely medical care.
Rank aggregation methods comparison: A case for triage prioritization
2013, Expert Systems with Applications
This paper seeks to test and to determine a suitable aggregation method to represent a set of rankings made by individual decision makers (DMs). A case study for triage prioritization is used to test the aggregation methods. The triage is a decision-making process with which patients are prioritized according to their medical condition and chance of survival on arrival at the emergency department (ED). There is a lot of subjective decision-making in the process which leads to discrepancies among nurses. Four rank aggregation methods are applied to the prioritization data and then an expert evaluates the results and judges them on practicality and acceptability. The proposed recommendation for preference aggregation is the method of the estimation of utility intervals. Expert opinion is highly valued in a decision-making environment such as this, where experience and intuition are key to successful job performance and outcomes.
A systematic review of the impact of afterhours care models on emergency departments, ambulance and general practice services
2011, Australasian Emergency Nursing Journal
Citation Excerpt :
There was no doubt that a proportion of these callers would have utilised other acute services.4,31,37 Early studies38–41 suggest that telephone advice centres could reduce ED activity up to two thirds and GP workload by 50%. A 12 month RCT in the UK42 identified 14,492 calls were received (7308 in the control arm; 7184 in the intervention arm).
The aim of the systematic review was to examine (i) the impact of afterhours primary care models on ED, ambulance services and or general practitioners and (ii) the effectiveness of these services (afterhours) on nurse practitioners and/or the medical doctors delivery of care.
Articles were assessed using the Critical Appraisal Skills Programme (CASP) making sense of evidence tools and covered the period from 1970 to 2011. The data sources searched were: Cumulative Index to Nursing and Allied Health literature, Medline, EMBASE, The Cochrane Database of Systematic Reviews, PubMed, Science Direct and Proquest.
A total of 2268 were retrieved and 419 studies were identified. Eighty-seven studies were found to be relevant. Nine countries are represented in the data. There were few relevant Randomised Controlled Trials (n = 5). The evidence was largely based on quasi experimental (time series), before and after or comparative studies. Studies were usually set within a single hospital or community setting with heterogeneous samples, short sample periods, and or measured a single outcome such as patient satisfaction.
Six models were identified from the review which highlighted evidence that afterhour care models can reduce GP workload and to a lesser extent ED and ambulance services. Potentially these models could ease acute care work load, improve access across the vast geographical distances of Australia.
ED patients: How nonurgent are they? Systematic review of the emergency medicine literature
2011, American Journal of Emergency Medicine
Citation Excerpt :
Among the 2 definitions found, the most frequent was based on the concept of “delay of care” (11 articles): the delay of care ranged between 3 and 72 hours [11,24-26,31,32,39,44,49,52,54]. Five articles were based on the duration of symptoms before ED consultation [27,29,36,40,42]; for example, Buesching et al [29] define as nonurgent a patient who presented in ED more than 72 hours after an injury. Six articles compared different methods of categorization in the same population [28,31,36,39,43,51].
Nonurgent visits to emergency departments (ED) are a controversial issue; they have been negatively associated with crowding and costs. We have conducted a critical review of the literature regarding methods for categorizing ED visits into urgent or nonurgent and analyzed the proportions of nonurgent ED visits. We found 51 methods of categorization. Seventeen categorizations conducted prospectively in triage areas were based on somatic complaint and/or vital sign collection. Categorizations conducted retrospectively (n = 34) were based on the diagnosis, the results of tests obtained during the ED visit, and hospital admission. The proportions of nonurgent ED visits varied considerably: 4.8% to 90%, with a median of 32 %. Comparisons of methods of categorization in the same population showed variability in levels of agreement. Our review has highlighted the lack of reliability and reproducibility

View all citing articles on Scopus

View full text

Original contributionInappropriate emergency department visits

Ann Emerg Med

Executive summary and comments

Yale studies in ambulatory medical care: Determinants of use of hospital emergency services

Am J Public Health

Emergency department use at two Hamilton hospitals

Can Med Assoc J

What is an emergency? Depends on whom you ask

JACEP

A study of consumer attitudes about health care: The role of the emergency room

Med Care

Original contribution
Inappropriate emergency department visits