Why are we waiting?

Maria Unwin, Leigh Kinsman, Scott Rigby. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints  International Emergency Nursing. published online September 13, 2016

Highlights:

•A large number of non-urgent emergency department (ED) patients would prefer to be seen by their general practitioner.

•The young (those under 25 years of age) have a disproportionately high attendance rate for non-urgent conditions.

•Perceived need and convenience are the most commonly cited reasons for choosing to attend ED with non-urgent complaints.

•Musculoskeletal symptoms were the most common presenting complaint amongst non-urgent patients.

•Cost was not a significant factor in the decision to attend the ED.

Abstract

Background

Emergency departments world-wide report service demands which exceed resource availability. Themes such as crowding, non-urgent presentations, ambulance diversion and access block have been linked to complications in care, poorer patient outcomes, increased morbidity and staff burnout. People attending the emergency department with problems perceived as non-urgent are frequently attributed blame for increased service demand, yet little is known from the patients’ perspective.

Method

This project utilised a descriptive cross-sectional waiting room survey of non-urgent patients to identify factors contributing to their decision making process to access ED services at a regional hospital in Tasmania, Australia. Data were analysed using a statistical software package and comparison made between the sample and population groups to determine broad representation.

Results

Patients’ decision making processes were found to be influenced by convenience, perceived need and referral by a health care provider. Cost did not present as a significant factor. A high incidence of patients under 25 years of age were identified and musculoskeletal complaints were the most common complaint across all age groups.

Conclusion

Further consideration is required to determine how to best meet service demand to facilitate the provision of the right service at the right time to the right patient.

‘They shouldn’t be coming to the ED, should they?’ A qualitative study of why patients with palliative care needs present to the emergency department

Green, E. et al. BMJ Supportive &  Palliative Care. Published online: 12 May 2016

Introduction: Across the developed world, there are concerns about ‘inappropriate’ use of the emergency department (ED). Patients with palliative care needs frequently attend the ED. Previous studies define the ‘reason’ for presentation as the ‘presenting symptom’, which ignores the perspectives of service users. This paper addresses an acknowledged gap in the literature, which fails to examine the decision-making process that brings patients to the ED.

Methods: In-depth narrative interviews were conducted with 7 patients (known to a specialist palliative care service and presenting to the ED during a 10-week period) and 2 informal caregivers. Analysis drew on ‘Burden of Treatment Theory’ to examine the meaning attributed by participants to their experience of serious acute illness, their capacity for action and the work required to access emergency care.

Results: 5 themes were identified about how and why emergency services were accessed: capacity for action, making sense of local services, making decisions to access emergency services, experience of emergency care and coping with change. All narratives captured concerns surrounding the complexity of services. Participants struggled to piece together the jigsaw of services, and were subsequently more likely to attend the ED. Differences between the ways that patients with chronic obstructive pulmonary disease and cancer accessed the ED were prominent.

Conclusions: Further work is needed to understand and respond to decisions leading patients with palliative care needs to the ED, particularly in the context of locally fragmented services, poor signposting and confusion about available healthcare. The perspectives of service users are essential in shaping emergency care.

Read the full article here