Understanding reasons for Emergency Department (ED) attendance in a metropolitan hospital

Jo-Anne McShane1, Andrew Maclean1, Julie Considine2

1 Emergency Department, Box Hill Hospital, Eastern Health, Victoria, Australia
2 Eastern Health – Deakin University Nursing and Midwifery Research Centre

Background
Our Emergency Department (ED) is located in a health service with three acute care sites and three ED’s. Following an above expected rise in presentations to one specific ED within the health service (16% in 12 months), we decided to look at why patients chose to present to our ED and the decision making process around their presentation.
Methods
This was a single-site cross-sectional study of patients (n=200) who were triaged to the main waiting room and fast-track waiting room (ATS 3-5) over a six week period from October- December 2015.
Patients were asked about:
• Their perception of the seriousness of their condition before ED arrival and while they were waiting (1=not serious at all to 10=serious).
• Their perception of the urgency of their condition before ED arrival and while they were waiting (1=not urgent at all to 10= serious).
• Factors considered prior to attending the ED.
• General perceptions and attitudes towards ED services.

Results
When making the decision to come to hospital patients rated their perception of the seriousness of their condition, with 52% rating themselves moderate to high (score 4-7), slightly increasing to 57.5% after arriving in the ED. A majority of patients (62%) rated themselves with the same level of seriousness pre and post presentation.

The perceived level of urgency at the time of making the decision to come to ED was 45%, (score 4-7) increasing to 51.5% after arriving in the ED. A majority of patients (68%) rated themselves the same level of urgency pre and post presentation.

There were many factors patients considered when presenting to the ED. Patients strongly felt that the hospital provided better care for their condition (59%), found it convenient to have all services in one place (55%), with the hospital being close by to where they live (58%). When deciding to attend the ED a majority of patients did not take into consideration the financial impact (68%) or issues around privacy (98.5%).
Patients had strong feelings in regards to general perceptions and attitudes towards ED services. Patients believed that people should only come to hospital if their illness is urgent or life threating (63%), with a majority of people saying that coming to the hospital for non-urgent illnesses was a misuse of the system (68%). Most patients felt that hospitals had the convenience of all facilities in one place (92%) and were willing to wait even if the ED was crowded (52.5%). They believed that hospital doctors and nurses are better specialised (63%) and even if they presented to a GP they would be referred to the hospital anyway (59.5%).
Conclusion
Patients present to the ED because they believe their condition is serious and urgent enough to warrant emergency care.

Biography

Jo-Anne is a Research Nurse and Clinical Nurse Specialist with over 16yrs experience in various Emergency Departments in Australia and overseas.