Emergency department (ED) crowding prevents the efficient and effective use of health services and compromises quality. Patients who use the ED for nonemergent health concerns may unnecessarily crowd ED services. In this article we describe characteristics of pediatric patients in the United States who use EDs for nonemergent visits.
We analyzed data from the 2002-2005 Medical Expenditure Panel Survey. The Medical Expenditure Panel Survey is conducted by the Agency for Healthcare Research and Quality and consists of a nationally representative sample of the civilian noninstitutionalized population of the United States. Our study sample consisted of 5512 person-years of observation. We included only ED visits for children from birth to 17 years of age with a specified International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code. The main dependent variable for our multivariate logistic model was nonemergent ED use, which was constructed by using the New York University ED-classification algorithm. Independent variables were derived from Andersen's Behavioral Model of Health Services Utilization.
We found that from 2002 to 2005, a nationally representative sample of US children from birth to 17 years of age used EDs for various nonemergent or primary care-treatable diagnoses. Overall, children from higher-income families had higher ED expenditures than children from lower-income families. Children with private insurance had higher total ED expenditures than publicly insured or uninsured children, but uninsured children had the highest out-of-pocket expenditures. We found that children from birth to 2 years of age were less likely to use the ED for nonemergent diagnoses (odds ratio [OR]: 0.13; P < .01) compared with older children. Non-Hispanic black children were also less likely to use the ED for nonemergent diagnoses (OR: 0.40; P = .03) than were non-Hispanic white children.
Children's sociodemographic characteristics were predictors of nonemergent use of ED services.
"Many studies on inappropriate ED visits use the New York University algorithm (NYU) to assess whether an ED visit is inappropriate or not (Ballard et al. 2010; Ben-Isaac et al. 2010; Tsai, Chen, and Liang 2011). This algorithm (recently validated) uses the ICD9-CM international diagnosis code to determine the probability of an ED visit to be a nonemergency, a primary care treatable emergency, a preventable or avoidable emergency, or a nonpreventable or avoidable emergency (Ballard et al. 2010). "
[Show abstract][Hide abstract] ABSTRACT: To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform.
A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010-2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated.
In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available.
The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health.
Health Services Research 02/2014; 49(4). DOI:10.1111/1475-6773.12161 · 2.78 Impact Factor
"Although previous studies have examined patient-and treatment-related factors associated with non-emergency visits to EDs, such as diagnosis, type of treatment required, and demographic and socioeconomic statuses      , the availability and/or use of primary care have been shown to be important contributing factors     . Two studies demonstrated that the lack of primary care was not the reason patients sought ED treatment for non-emergencies  . "
[Show abstract][Hide abstract] ABSTRACT: Objectives:
To quantify dynamic availability of ambulatory care, and to examine possible associations with non-emergency treatments in emergency departments (EDs).
Longitudinal data from the Taiwan National health Insurance Research Database were used to evaluate 749,584 emergency-medicine cases occurring between 2005 and 2010 according to a modified New York University algorithm. Multivariable-cumulative-logistic-regression analysis with generalized estimating-equation methods was used to determine associations between availability of ambulatory care and the urgency of patients' medical needs during ED visits.
More than half (53.04%) of the ED visits that were evaluated in our study were classified as non-emergencies, and over half of these occurred despite a high availability of ambulatory care facilities (median > 96%). Compared with patients in areas with a low availability of ambulatory care, patients in areas of medium to high availability showed approximately 0.8 times lower odds ratios for associations with non-emergency ED visits.
Non-emergency ED visits may be reduced by increasing the availability of ambulatory care facilities in areas with deficits in the availability of such facilities. However, increasing the availability of ambulatory care by raising the number of available ambulatory care physicians or the number of ambulatory care facilities may not reduce non-emergency ED visits in areas with medium to high availability of ambulatory care facilities.
Health Policy 01/2013; 110(2-3). DOI:10.1016/j.healthpol.2012.12.003 · 1.91 Impact Factor
"The inappropriate use and/or misuse of ED services is one of the common problems leading to overcrowding . Sociodemographic characteristics are predictors of nonurgent use of emergency department . Public orientation , strengthening and expanding primary care services can be a solution to the problem [6,7]. "
[Show abstract][Hide abstract] ABSTRACT: Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency.
In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.
We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.
BMC Emergency Medicine 10/2011; 11(1):16. DOI:10.1186/1471-227X-11-16
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