Emergency Department utilization characteristics and evaluation for patient visit appropriateness from the patients’ and physicians’ point of view

Abstract

Objectives: Many patients present to emergency departments (ED) with nonurgent complaints. Inappropiate visits may contribute to emergency department overcrowding. This study aims to investigate the causes of inappropriate visits and to assess urgency from the patient and physician point of view.
Materials and Methods: All consecutive adult patients referred to the ED during a 28-day period were enrolled in this cross sectional study. Demographic and socioeconomic variables and reasons for the visits were recorded. NRS (Numeric Rating Scale) was used to rate perceptions regarding urgency of the current visit. Resident physicians taking care of the patients also rated their opinions of appropriateness of ED utilization on NRS. All patients were categorized as to their appropriateness for ED care.
Results: 2.351 (92,8%) out of 2.533 patients provided complete data sets. 67.8% of visits were catagorized as appropriate for ED care by the resident. Lower NRS scores were encountered younger patients, women, single, with higher levels of educated and those who visited the ED for institutional reputation. Availability of health insurance did not contribute to a statistically significant difference with regarding appropriateness of visits. Patient and physician perceptions of appropriateness were significantly correlated.
Conclusion: Our results show that there is agreement between patient and physician perception of urgency regarding ED visits. Availability of health insurance was not associated with less “inappropriate” ED utilization. Single, female, educated patients with a higher socioeconomic standing visited the ED inappropriately more frequently.. Future studies are required to futher investigate issues related to inappropriate visits.