Over-use of emergency departments (EDs) by patients with primary care problems is a matter of concern. I studied patients and carers of children attending the family medicine clinics in the ED of Al-Bashir Hospital in Amman, Jordan1 from May to July 2011, during office hours (Sunday to Thursday, 8:00–16:00) to determine their main reason for choosing this service rather than a GP or medical centre.
A total of 1310 patients attended: 747 (57%) were adults, 563 (43%) were children accompanied by carers and 778 (59%) were female and 532 (41%) male. Reasons for attending were: 374 (29%) self-assessed urgency, 301 (23%) convenience (accessible and less waiting time), 231 (18%) self-assessed seriousness, 143 (11%) took treatment but still not well, 122 (9%) referred from other facilities, 97 (7%) needed a second opinion, and 42 (3%) were related to sick leave.
Siminski et al’s survey in Australia2 suggested three important reasons: urgency, being able to see the doctor and have tests or X-rays done in the same place, and the seriousness or complexity of the health problem.1 The EMPATH study in the US3 identified five factors characterising patient’s principal reasons for seeking ED care, with medical necessity the most frequent, followed by ED preference, convenience, affordability, and limitations of insurance.
There is an important distinction between clinically-assessed triage categories and self-assessed urgency and complexity. Patients can only be expected to act on their own judgement.2 Use of the ED is for most people an affirmative choice over other providers, rather than a last resort, and it is often a choice driven by lack of access or dissatisfaction with other providers.3
- © British Journal of General Practice 2014