Table 3.

Perceptions of ED health professionals regarding nonurgent ED patients

Theme and sub-category	Descriptors
Theme 1. Problem of defining a nonurgent visit and an inappropriate visit
No specific definition	▪ “It’s easy to consider a nonurgent case at the end of the consultation, but it's very difficult in the triage area.”
Perception of what constitutes a nonurgent case	▪ “Anything that is not life-threatening.”
	▪ “A condition is nonurgent if it can be treated in 2 to 3 days.”
	▪ “Consultations are nonurgent if the chief complaint is a non-serious illness that can be treated by a PCP.”
Difference between nonurgent cases and inappropriate cases	▪ “If no other sources of care are available, patients have no other choice but to go to the ED. In this case, a nonurgent consultation could be considered appropriate.”
	▪ “All patients whose care can be given at a facility other than the ED.” ▪ “We must redefine what is an emergency, what is an appropriate visit to the
	ED, and what is inappropriate, but it is very difficult to define.”
Theme 2. Reasons for using EDs for nonurgent complaints
Lack of access to PCPs	▪ “PCPs are not available evenings and weekends…”
	▪ “Continuity of care in primary care services is not guaranteed on Saturdays and Sundays.”
	▪ “In some geographical sectors, there is virtually no primary health care structure ensuring continuity of care. EDs are the only medical places available 24 hours a day, seven days a week.”
Health care consumerism	▪ “The use of care is similar to that of products, i.e. fast and easy… We are in the Internet age, where everything is readily available, and the use of health care is no exception to this trend.”
	▪ “The population evolves towards the need for rapid response to a need.”
	▪ “People want to receive care on the same day, including access to technical facilities.”
	▪ “Frustration is not acceptable”.
No advance payment at the time of the ED visit	▪ “Some patients come to EDs for financial reasons. There is a perception that the hospital is free, but it is not.”
	▪ “People believe that the medical consultation is free at the time of the ED visit, but the consultation is supported by our health insurance system.”
Theme 3. Consequences of the increase in nonurgent ED visits
	▪ “It is a problem when there are peaks of activity…This increase in utilization of EDs has induced overcrowding, prolonged wait times, delayed diagnosis and treatments, reduced quality of care, and increased the risk of adverse outcomes.”
	▪ “Most ED colleagues are stressed because EDs are not structured for primary care.”
	▪ “They (ED colleagues) feel that they no longer practice emergency medicine.”
Theme 4. Solutions to reduce the number of ED visits for nonurgent complaints
Patient education	▪ “We should communicate more about what is a real urgent problem.”
	▪ “Perhaps if people were educated regarding the importance of primary care and the appropriate use of EDs, they might seek ED care less often.”
To reorganize the health care system by improving the continuity of care outside regular business hours	▪ “We could have primary care consultations in close proximity to the ED. These consultations would be opened between 8 a.m. and midnight. When there is a real emergency, patients would be sent back to the ED.”
	▪ “A working collaboration between EDs and PCPs would improve accessibility to ensure that services are used effectively and efficiently.”
To integrate a “gatekeeper” at the ED	“To determine patients having authorization for care in ED, a physician should discern whether the consultation is appropriate or not.”
A financial penalty for patients categorized as nonurgent after the consultation	▪ “If it’s not urgent, we look after you, but you will pay - you will pay at least an “emergency fee”;
	▪ “No significant financial penalties to prevent the use of EDs exist.”