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Description of non-urgent patients in the emergency department

Authors:
Hasan İdil at Tepecik Training and Research Hospital
Hasan İdil
Turgay Yılmaz Kilic
Turgay Yılmaz Kilic
Turgay Yılmaz Kilic
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Murat Yesilaras at Tepecik Training and Research Hospital
Murat Yesilaras
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Correspondence
Description of non-urgent patients in the emergency department
The emergency department (ED) overcrowding is a major public
health problem worldwide. One of the important reasons for this is
the frequent use of ED by non-urgent patients (1). Crowded EDs
negatively impacts the quality of patient care and the satisfaction
of patients and staff of the ED (1). For this reason, many studies
have been carried out to investigate the characteristics of these pa-
tients and the reasons for their choosing the ED.
It is important how the “non-urgent patients”are described in
the studies. Worldwide accepted criteria for this situation have
not yet been established. This important issue should be taken
into account when planning studies on this subject.
There are some differences on identifying patients among
related studies as non-urgent. Patients are usually categorized by
a nurse (88%) or a physician, in the triage unit (2). In this phase com-
plaints, vital signs, and waiting times are taken into account (2). In
general, patients who do not need urgent intervention and can be
treated in primary care units are described as non-urgent (2).
Triage levels are helpful in categorizing patients as non-urgent.
No special triage category has been identified for non-urgent pa-
tients. However, they are often included in the lowest level of ur-
gency (3). It is not difficult to distinguish these patients from
urgent patients in crowded EDs where non-urgent patients are
treated in an additional unit, known as ''fast-track''.
In the triage system used in Turkey, patients are grouped as
green, yellow or red starting from the lowest level of urgency.
Then, the patients in the yellow and red categories are divided
into two subgroups according to their urgency ratings (4). The
green (Level 5) category includes patients who are not urgent and
can be examined at primary care units or outpatient clinics. This
five-level triage system is derived from the Canadian Emergency
Department Triage and Acuity Scale (CTAS).
It remains uncertain which of the ED patients should be consid-
ered as “non-urgent". At this point, it is necessary to determine the
objective criteria that can guide. For this purpose extensive litera-
ture reviews, additional studies and expert opinions are needed.
Conflicts of interest
The authors declare that there is no conflict of interest.
Financial disclosure
This study has received no financial support.
References
1. Moskop JC, Sklar DP, Geiderman JM, et al. Emergency department crowding, part
1-concept, causes, and moral consequences. Ann Emerg Med. 2009;53, 605-11.
2. Durand AC, Gentile S, Devictor B, et al. ED patients: how nonurgent are they?
Systematic review of the emergency medicine literature. Am J Emerg Med.
2011;29:333e345.
3. Idil H, Kilic TY, Toker I, et al. Non-urgent adult patients in the emergency depart-
ment: causes and patient characteristics. Turk J Emerg Med. 2018;2:71e74.
4. Public Hospitals Institution of Turkey Database; 2014. Web site. Available at:
http://www.tkhk.gov.tr/828_tebligler.
Hasan Idil
*
, Turgay Yılmaz Kilic
Attending Physician of Emergency Medicine, Tepecik Training and
Research Hospital, Department of Emergency Medicine, Izmir, Turkey
Murat Yesilaras
Associate Professor of Emergency Medicine, Tepecik Training and
Research Hospital, Department of Emergency Medicine, Izmir, Turkey
*
Corresponding author. Department of Emergency Medicine,
Tepecik Training and Research Hospital, Yenisehir, 35120, Izmir,
Turkey.
E-mail address: hsnidil@gmail.com (H. Idil).
31 May 2018
Available online xxx
Peer review under responsibility of The Emergency Medicine Association of
Turkey.
Contents lists available at ScienceDirect
Turkish Journal of Emergency Medicine
journal homepage: http://www.elsevier.com/locate/TJEM
Turkish Journal of Emergency Medicine xxx (2018) 1
https://doi.org/10.1016/j.tjem.2018.06.001
2452-2473/Copyright ©2018 The Emergency Medicine Association of Turkey. Production and hosting by Elsevier B.V. on behalf of the Owner. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Idil H, et al., Description of non-urgent patients in the emergency department, Turkish Journal of Emergency
Medicine (2018), https://doi.org/10.1016/j.tjem.2018.06.001
... This negatively affects patient care quality and satisfaction with patients and ES personnel. [2] Furthermore, it causes excessive healthcare spending, unnecessary tests and treatment, and missed opportunities to foster long-term relationships with primary care physicians, who are key members of primary healthcare. [1] In Turkey, ES operate according to the Anglo-American model. ...
... [5] The attendance of nonurgent patients in ES has become a major global public health issue. [2] ES worldwide face a growing burden as patient attendance continues to increase. In the United Kingdom and the United States, more than 139 million and 23.8 million patients sought care in hospital emergency departments in 2017, respectively, while Australia witnessed an attendance of 8 million. ...
... [14] Studies have been conducted to determine the reasons for nonurgency visits of patients and have found that it is multidimensional. [2,15,16] This study aimed to investigate why patients chose to self-refer to the emergency department instead of their primary care health center for nonurgent complaints. Our goal was to determine the specific characteristics of the adults themselves, their complaints, their FPs, and the relationship between the patients and their FPs that influences this decision-making process. ...
Why patients self-refer to the emergency service for nonurgency?: A mix-method survey from a family medicine perspective
Article
Full-text available
  • Mar 2024
  • MEDICINE
The definition of “nonurgent emergency service visits” is visits to conditions for medical conditions that require attention but are not life-threatening immediately or severe enough to require urgent intervention. This study aims to investigate the reasons why patients choose to self-refer to the emergency service (ES) instead of their primary care health center for nonurgent complaints. The study was carried out in a tertiary hospital. The survey consisted of 2 parts with sociodemographic questions, knowledge of their family physician, and the reason why it has been applied to the ES with multiple choice answers. Of the 325 patients, the mean age was 34.5 years and 54.2% were women. Also, 26 of the patients were reported as “urgent” by the doctor. The main reasons underlying self-referred patients were classified into 4 themes: “urgency” (13.8%), advantages of ES (12.9%); disadvantages of primary care (25.1%), and other (45.9%). The most common reason patients self-refer to the ES was their belief in “being urgent” (61%). In this study, 26.8%, (n = 84) of the patients are not happy with their family physicians, while only 13.2% (N = 43) prioritize the ES advantages.
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... In the literature, there are several efforts noted to understand the presence of non-urgent patients in EDs and their underlying motivations. Scholars reported motivations such as patients' over-estimating their illness severity, patients believing that the general practitioner (GP) would be unable to help or was unavailable, as well as some subjects simply being closer to the ED than their local GP facility (Bianco et al., 2003;Atenstaedt et al., 2015;Andrews and Kass, 2018;Idil et al., 2018). Regardless of several studies presented, showing the causes of the non-urgent presence in EDs, there is still a challenge to understand the impact of such behaviour in this context. ...
... The main purpose of the EDs, to provide urgent and emergency treatment without the requirement of a schedule, has been misinterpreted by some patients that do not class as Impact of nonurgent patients in EDs' operations urgent (Afilalo, 2004;Tsai et al., 2010;Idil et al., 2018). Therefore, patients in non-urgent conditions are visiting EDs and creating challenges in the healthcare system, which has to deal with a patient's unbalanced demand and a lower illness severity (Andrews and Kass, 2018). ...
... Amongst these reasons, there are three which the literature underscores as the most common: (1) patients chose the ED for its convenience (e.g. Alyasin and Douglas, 2014;Schmiedhofer et al., 2017;Idil et al., 2018). According to Unwin et al. (2016) EDs worldwide are designed to be convenient and to provide emergency care for those most in need. ...
The impact of non-urgent patients in emergency departments' operations
Article
  • Aug 2020
  • Int J Qual Reliab Manag
Abstract Purpose Globally, the presence of non-urgent patients in emergency departments (EDs) is considered one of the main reasons for creating excessive waiting times and overcrowding in units. This paper aims to understand the impact of non-urgent patients in EDs' operations. Design/methodology/approach This study is based on qualitative case studies conducted within two Brazilian EDs, and uses interviews and observations to access the data. Findings From a thematic analysis, three key themes emerged: characteristics of non-urgent demands in EDs, negative aspects of non-urgent patients in EDs, and the impact of the healthcare system model on EDs. These themes bring to light the impact that non-urgent patients have in EDs' operations, and provide theoretical and practical implications. Research limitations/implications The limitation of this work is bound by the understanding of the non-urgent demands in EDs. Therefore, a benchmarking approach (investigating state-of-the-art practices to avoid such impact) was not applied but was suggested for future research instead. Practical implications The research provides significant contributions to practitioners and policymakers, aiding future discussions to improve healthcare coverage and performance. Social implications The research provides significant contributions for managers and policymakers, aiding future discussions to improve healthcare. For instance, the use of well-known techniques (e.g. lean, six sigma) are discussed and suggested to enhance healthcare capacity and performance. Furthermore, the policymakers are called upon to evaluate the healthcare access and provide regulations that involve innovative approaches to widen healthcare access. Originality/value Based upon empirical data, this research extends the discussions related to non-urgent patient in EDs and is not limited merely to descriptive analysis, but by providing practical propositions and discussions related to the impact of these patients' presence in EDs' operations. Finally, the research provides a range of suggestions for future research related to the EDs' operational performance.
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Non-urgent adult patients in the emergency department: Causes and patient characteristics
Article
Full-text available
  • Apr 2018
Objective: Non-urgent patients are one of the important causes of emergency department (ED) overcrowding. In this study, it is aimed to identify the characteristics of these patients and the reasons why they prefer the ED. Method: This study was conducted during regular office hours. The characteristics of non-urgent patients, their complaints, the frequency of visits to family physicians (FPs), the frequency of using the Central Hospital Appointment System (CHAS) and reasons for preferring the ED were questioned by a questionnaire. Results: This study was conducted on 624 patients. Among them, 326 (52.2%) were male. The mean age was 38.4 years (SD: 14.4). It was identified that 80.3% of the patients had no chronic disease and that 97.4% had health insurance. The most common complaints at presentation were musculoskeletal system pain (25.2%) and upper respiratory tract infections symptoms (19.7%). It was identified that 28.7% of the patients did not prefer to visit their FPs and that 48.6% did not use the CHAS. The reasons of preferring ED were as follows: rapid physical examination (36.4%), not being able to book an earlier appointment at alternative health facilities (30.9%), being close to the facility (12.8%) and being at the hospital for a different reason (12.3%). Among the patients, 20.2% did not express any particular reason. Conclusions: Non-urgent patients who admitted to the ED are mostly middle-aged patients with no chronic disease. They usually visit the ED for preventable reasons. The use of alternative health facilities and CHAS should be encouraged.
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Ed Patients: How Nonurgent Are They? Systematic Review of the Emergency Medicine Literature
Article
  • Mar 2011
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.
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Emergency Department Crowding, Part 1-Concept, Causes, and Moral Consequences
Article
  • Dec 2008
Crowding is an increasingly common occurrence in hospital-based emergency departments (EDs) across the globe. This 2-article series offers an ethical and policy analysis of ED crowding. Part 1 begins with a discussion of terms used to describe this situation and proposes that the term "crowding" be preferred to "overcrowding." The article discusses definitions, measures, and causes of ED crowding and concludes that the inability to transfer emergency patients to inpatient beds and resultant boarding of admitted patients in the ED are among the root causes of ED crowding. Finally, the article identifies and describes a variety of adverse moral consequences of ED crowding, including increased risks of harm to patients, delays in providing needed care, compromised privacy and confidentiality, impaired communication, and diminished access to care. Part 2 of the series examines barriers to resolving the problem of ED crowding and strategies proposed to overcome those barriers.
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