Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T21:56:48.671Z Has data issue: false hasContentIssue false
  • English
  • Français

Rural emergency department use by CTAS IV and V patients

Published online by Cambridge University Press:  21 May 2015

Sandra Steele ,
Danielle Anstett  and
W. Ken Milne
Sandra Steele
Affiliation:
University of Queensland School of Medicine, Brisbane, Australia
Danielle Anstett
Affiliation:
National University of Ireland, Galway, Ireland
W. Ken Milne*
Affiliation:
Department of Family Medicine, Faculty of Medicine and Dentistry, University of Western Ontario, Exeter, Ont.
*
Department of Family Medicine, Faculty of Medicine and Dentistry, University of Western Ontario, South Huron Hospital, 24 Huron St. W., Exeter ON N0M 1S2; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

For a variety of reasons, many emergency department (ED) visits are classified as less- or nonurgent (Canadian Triage and Acuity Scale [CTAS] level IV and V). A recent survey in a tertiary care ED identified some of these reasons. The purpose of our study was to determine if these same reasons applied to patients presenting with problems triaged at a similar level at a low-volume rural ED.

Methods:

A 9-question survey tool was administered to 141 CTAS level IV and V patients who attended the South Huron Hospital ED, in Exeter, Ontario, over a 2-week period in December 2006.

Results:

Of the 141 eligible patients, 137 (97.2%) completed the study. One hundred and twenty-two patients (89.1%) reported having a family physician (FP) and 53 (38.7%) had already seen an FP before presenting to the ED. Just over one-half of all patients (51.1%) had their problem for more than 48 hours, and 42 (30.7%) stated that they were referred to the ED for care. Fifty-three (38.7%) of the respondents felt they needed treatment as soon as possible. Many patients reported coming to the ED because: 1) their FP office was closed (21.9%); 2) they could not get a timely appointment (16.8%); or 3) the walk-in clinic was closed (24.8%). Only 6 patients (4.4%) specifically stated that they came to the ED because they had no FP. One-third of patients attended the ED because they believed it offered specialized services.

Conclusion:

In this rural setting, most less- or nonurgent ED patients had an FP yet they went to the ED because they did not have access to primary care, because they perceived their problem to be urgent or because they were referred for or sought specific services.

Keywords

nonurgentlow acuityCanadian Emergency Department Triage and Acuity ScaleCTASrural ED
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 3 , May 2008 , pp. 209 - 214
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Vertesi, L. Does the Canadian Emergency Department Triage and Acuity Scale identify non-urgent patients who can be triaged away from the emergency department? CJEM 2004;6:337–42.CrossRefGoogle ScholarPubMed
2.Canadian Association of Emergency Physicians and the National Emergency Nurses Affiliation. Access to acute care in the setting of emergency department overcrowding [joint position statement]. CJEM 2003;5:81–6.Google Scholar
3.Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. CJEM 1999;1(3 suppl). Available: http://www.caep.ca (accessed 2007 Feb 4).Google Scholar
4.Young, GP, Wagner, MB, Kellermann, AL, et al. Ambulatory visits to hospital emergency departments. JAMA 1996;276:460–5.Google Scholar
5.Sempere-Selva, T, Peiro, S, Sendra-Pina, P, et al. Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons — an approach with explicit criteria. Ann Emerg Med 2001;37:568–79.CrossRefGoogle ScholarPubMed
6.Buesching, DP, Jablonowski, A, Vesta, E, et al. Inappropriate emergency department visits. Ann Emerg Med 1985;14:672–6.CrossRefGoogle ScholarPubMed
7.Lowe, RA, Bindman, AB. Judging who needs emergency department care: a prerequisite for policy-making. Am J Emerg Med 1997;15:133–7.CrossRefGoogle Scholar
8.Murphy, AW. ’Inappropriate’ attenders at accident and emergency departments I: definition, incidence and reasons for attendance. Fam Pract 1998;15:23–32.Google Scholar
9.Gill, JM. Nonurgent use of the emergency department: appropriate or not? Ann Emerg Med 1994;24:953–7.CrossRefGoogle ScholarPubMed
10.Northington, WE, Brice, JH, Zou, B. Use of an emergency department by nonurgent patients. Am J Emerg Med 2005;23:131–7.CrossRefGoogle ScholarPubMed
11.Richardson, LD, Hwang, U. Access to care: a review of the emergency medicine literature. Acad Emerg Med 2001;8:1030–6.Google Scholar
12.Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding. CJEM 2001;3:82–8.Google Scholar
13.Coleman, P, Irons, R, Nicholl, J. Will alternative immediate care services reduce demands for non-urgent treatment at accident and emergency? Emerg Med J 2001;18:482–7.CrossRefGoogle ScholarPubMed
14.Boushy, D, Dubinsky, I. Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient’s perspective. J Emerg Med 1999;17:405–12.CrossRefGoogle Scholar
15.Field, S, Lantz, A. Emergency department use by CTAS Levels IV and V patients. CJEM 2006;8:317–22.CrossRefGoogle ScholarPubMed
16.Cook, S, Sinclair, D. Emergency department triage: a program assessment using the tools of continuous quality improvement. J Emerg Med 1997;15:889–94.Google Scholar
17.Murray, M, Bullard, M, Grafstein, E; CTAS and CEDrosoph Inf Serv National Working Groups. Revisions to the Canadian Emergency Department Triage and Acuity Scale Implementation Guidelines. CJEM 2004;6:421–7.Google Scholar
18.Sarver, JH, Cydulka, RK, Baker, DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med 2002;9:916–23.CrossRefGoogle ScholarPubMed
19.Murphy, AW. ‘Inappropriate’ attenders at accident and emergency departments II: heath service responses. Fam Pract 1998;15:33–7.Google Scholar
20.Schull, M, Kiss, A, Szalai, JP. The effect of low-complexity patients on emergency department waiting times. Ann Emerg Med 2007;49:257–64.Google Scholar
21.Burnett, MG, Grover, SA. Use of emergency department for nonurgent care during regular business hours. CMAJ 1996;154:1345–51.Google Scholar
22.Siminski, P, Cragg, S, Middleton, R, et al. Primary care patients’ views on why they present to emergency departments: Inappropriate attendances or inappropriate policy? Austr J Primary Health 2005;11:87–95.CrossRefGoogle Scholar
23.Afilalo, M, Guttman, A, Colacone, A, et al. Emergency department use and misuse. J Emerg Med 1995;13:259–64.Google Scholar
24.Gifford, MJ, Franaszek, JB, Gibson, G. Emergency physicians’ and patients’ assessments: urgency of need for medical care. Ann Emerg Med 1980;9:502–7.Google Scholar