Appropriateness of emergency department visits in a Portuguese University hospital

Abstract

Study objective: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. Methods: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. Results: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier. According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM . Conclusions: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants. [Pereira S, Oliveira e Silva A, Quintas M, Almeida J, Marujo C, Pizarro M, Angélico V, Fonseca L, Loureiro E, Barroso S, Machado A, Soares M, da Costa AB, de Freitas AF. Appropriateness of emergency department visits in a Portuguese university hospital. Ann Emerg Med. June 2001;37:580-586.]

Introduction

Overcrowding in public hospital emergency departments has become a major concern in developed countries.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Inappropriate use of the ED for nonurgent problems has been suggested as a probable contributor to ED overcrowding1, 3, 5, 6, 7, 13, 14, 15, 16 and to an increase in health care costs.6, 13 The burden of inappropriate ED visits was estimated at different settings according to distinct criteria for determining the appropriateness of an ED visit.1, 12, 13, 17, 18 However, a generalization of these estimates is restricted by the lack of a universally accepted measurement of what constitutes an appropriate ED visit.1, 5, 12, 17, 18 As in other countries, factors for overcrowding in Portuguese EDs are assumed to be a consequence of inappropriate ED overuse.⁸ No studies in Portugal, at this time, have been concluded to support this assumption. The aim of this study was to determine the prevalence of appropriate ED visits in the setting of a major Oporto public teaching hospital and to assess factors associated with an appropriate ED visit.