Research
Patients' Perspective on Choosing the Emergency Department for Nonurgent Medical Care: A Qualitative Study Exploring One Reason for Overcrowding

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Introduction

For decades it has been known that patients use emergency departments for nonurgent care needs. This study was conducted to help determine how the health care community can assist patients achieve consistent health care while meeting the patient's perceived needs.

Method

A descriptive qualitative study was conducted based on interviews with 31 persons between 22 and 43 years of age following an ED visit for a nonurgent medical need. Exploration of the patient's perception was accomplished through open-ended questions in a structured interview format. Data were analyzed using content analysis.

Results

Patients who participated in our study revealed 3 major themes: (1) They were unable to obtain an appointment with a primary care provider (PCP); (2) they were referred by the staff (not the doctor) in PCPs' offices to be evaluated in the emergency department; and (3) it took less of their time to be seen in the emergency department than it did to contact their PCP, only to then be told to go to the emergency department.

Discussion

The findings of this study support the need for health care providers to find ways to provide nonurgent care in a timely and efficient manner. Multiple options for providing this care need to be conceived and evaluated.

Section snippets

Research Design and Data Collection

Using a qualitative descriptive design, we examined the research question: “Why do people choose to come to the emergency department instead of their primary care provider (PCP) with nonurgent medical complaints?” We sought to provide a comprehensive summary of events in common, everyday language21 that would reveal more in-depth and rich information than a quantitative description. Overall themes and patterns were assessed with a content analysis.22

Sample

The convenience sample consisted of persons

Theme One

People used the emergency department because they have been told to do so by staff in their PCP's office. One participant said, “I called my doctor about my nose and they said that they were booked up, to go to the ER and they would call ahead.” “I like him (speaking of her PCP), but it is impossible to see him if you are sick,” said another participant. This 38-year-old woman was instructed by staff in her PCP's office to seek medical care at a nearby emergency department for her head

Discussion

Prior to this study, we initially agreed with Lucas and Stanford's conclusion that patients came to the emergency department with nonurgent complaints because they believed their conditions were urgent or emergent.7

Summary

Health care has changed. The traditional view of the emergency department being used for emergencies only is no more. The care of nonurgent conditions in the emergency department, for reasons found in this study (primarily time), has implications affecting health care as a whole. Models that work to achieve the goals of consumers, such as fast tracks, free-standing clinics that see patients without an appointment, and referring out of the emergency department to community resources, need to be

Acknowledgment

This study was completed as part of the requirements for the Master of Nursing Science at the University of Southern Indiana. We thank Jeri Burger for her assistance with the data analysis for this study.

Matthew S. Howard, River Cities Roadrunner Chapter, is Injury Prevention Coordinator, St Mary's Trauma Services, St Mary's Medical Center, Evansville, Ind.

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  • Cited by (0)

    Matthew S. Howard, River Cities Roadrunner Chapter, is Injury Prevention Coordinator, St Mary's Trauma Services, St Mary's Medical Center, Evansville, Ind.

    Barbara A. Davis is Professor, College of Nursing and Health Professions, University of Southern Indiana, Evansville, Ind.

    Crystal Anderson is Staff Nurse, Emergency Department, Western Baptist Hospital, Paducah, Ky.

    Diane Cherry, Pennyrile Chapter, is Safe Communities Program Director, Western Baptist Hospital, Paducah, Ky.

    Patricia Koller, Kentucky ENA State Council, Three Rivers Chapter, is Emergency Services Educator, Owensboro Medical Health System, Owensboro, Ky.

    Derek Shelton, Three Rivers Chapter, is Emergency Department Clinical Supervisor, Owensboro Medical Health System, Owensboro, Ky.

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