Abstract
The appropriate use of emergency departments is of growing concern. By knowing which patients are more likely to make inappropriate visits to these departments, efforts can be directed to encourage more suitable care. Our study was done in a rural county hospital in eastern New Mexico. Data were collected from all emergency department visits over a 4-week period. Patient and physician questionnaires were administered to assess aspects of emergency department use, including appropriateness based on published criteria, physicians' opinion of appropriateness, groups who made inappropriate visits, and the perception of the need for and the urgency of a visit. We found that 32% of visits were inappropriate based on published criteria and 24% were considered inappropriate by physician opinion. Two groups with a high rate of inappropriate visits were Hispanics and Medicaid recipients. Patients and physicians have differing opinions of the urgency of a visit and of how soon medical treatment is required. To decrease the frequency of inappropriate use of emergency departments, educational efforts should be focused on the subgroups with high rates of such use.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bellavia J., Brown D. Accident and emergency. A misuse of resources. 1991 Oct 30-Nov 5Nurs Times. 87(44):26–29. [PubMed] [Google Scholar]
- Buesching D. P., Jablonowski A., Vesta E., Dilts W., Runge C., Lund J., Porter R. Inappropriate emergency department visits. Ann Emerg Med. 1985 Jul;14(7):672–676. doi: 10.1016/s0196-0644(85)80886-6. [DOI] [PubMed] [Google Scholar]
- Davido A., Nicoulet I., Levy A., Lang T. Appropriateness of admission in an emergency department: reliability of assessment and causes of failure. Qual Assur Health Care. 1991;3(4):227–234. doi: 10.1093/intqhc/3.4.227. [DOI] [PubMed] [Google Scholar]
- Driscoll P. A., Vincent C. A., Wilkinson M. The use of the accident and emergency department. Arch Emerg Med. 1987 Jun;4(2):77–82. doi: 10.1136/emj.4.2.77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hansagi H., Edhag O., Allebeck P. High consumers of health care in emergency units: how to improve their quality of care. Qual Assur Health Care. 1991;3(1):51–62. doi: 10.1093/intqhc/3.1.51. [DOI] [PubMed] [Google Scholar]
- Nelson D. A., Nelson M. A., Shank J. C., Thompson F. L. Emergency room misuse by medical assistance patients in a family practice residency. J Fam Pract. 1979 Feb;8(2):341–345. [PubMed] [Google Scholar]
- Powers M. J., Reichelt P. A., Jalowiec A. Use of the emergency department by patients with nonurgent conditions. J Emerg Nurs. 1983 May-Jun;9(3):145–149. [PubMed] [Google Scholar]
- Vayda E., Gent M., Hendershot A. Emergency department use at two Hamilton hospitals. Can Med Assoc J. 1975 Apr 19;112(8):961–965. [PMC free article] [PubMed] [Google Scholar]
- Wabschall J. M. Why parents use the emergency department for nonemergency infant care. J Emerg Nurs. 1983 Jan-Feb;9(1):37–40. [PubMed] [Google Scholar]
- Weinerman E. R., Ratner R. S., Robbins A., Lavenhar M. A. Yale studies in ambulatory medical care. V. Determinants of use of hospital emergency services. Am J Public Health Nations Health. 1966 Jul;56(7):1037–1056. doi: 10.2105/ajph.56.7.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yarboro T. L. Emergency room use by patients from the family practice of a black physician. J Natl Med Assoc. 1990 Feb;82(2):93–97. [PMC free article] [PubMed] [Google Scholar]
- de Alteriis M., Fanning T. A public health model of Medicaid emergency room use. Health Care Financ Rev. 1991 Spring;12(3):15–20. [PMC free article] [PubMed] [Google Scholar]