Emergency Department Nonurgent Visits in Iran: Prevalence and Associated Factors
Assistant Professor, Department of Emergency Medicine, Tehran University of Medical Sciences, Imam Hospital Complex, Keshavarz Blvd, Tehran, Iran. E-mail: .The American journal of managed care (Impact Factor: 2.26). 02/2013; 19(1):e1-8.
Objectives: To estimate the number of emergency department (ED) visits due to nonurgent problems and to describe the characteristics of those patients, as well as their reasons for presenting to the ED. Study Design: Descriptive cross-sectional study. Methods: In this study, all adult (aged >15 years) patients presenting to the ED over a 2-week period were evaluated. Data regarding the age, sex, marital status, educational level, and insurance status of all patients were recorded. The time and date of the presentation were also noted. Those classified by the triage nurse as having nonurgent conditions were surveyed regarding their reasons for presenting to the ED. Results: Out of 1923 visits, 400 (20.8%) were classified as nonurgent. The prevalence of inappropriate ED visits was slightly greater in patients aged 15 to 49 years. Patients whose visits were paid for by health insurance accounted for the majority of inappropriate visits (82.75%). There were higher rates of inappropriate visits in the evening and night shifts compared with morning and afternoon shifts (17.39% vs 25.03%). The most common reason for presenting to the ED was "to obtain rapid treatment" (76.5%); only 10.75% presented because of a perceived urgent problem. Conclusions: The results of our study corroborate the previous findings that inappropriate use of the ED is common. The prevalence of presentation for nonurgent problems was substantive between 6 PM and 6 AM. Gender, marital status, education, insurance, and day of the week had no association with nonurgent presentation.
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ABSTRACT: The relation between physical access in emergency department (ED) and the time patients have to wait before being served is unknown. Our objective was to discover the associations between the physical access in ED and the time patients had to wait before receiving services. In this cross-sectional study, statistical society comprised two portions, namely, public hospitals' EDs and referred patients to the ward. Data on waiting time for 240 patients in six public and private hospitals were gathered. In addition, physical condition of EDs was inspected by visiting these hospitals. A designed checklist, based on the introduced physical space, was filled for each hospital. Results of the checklist were scored using Likert's five-points scale and Spearman and Pearson's correlation coefficient were applied to determine the relationship between physical access and waiting time. The correlation between the waiting time beginning from the very moment of stepping into the ward until first examination and physical condition at the triage wards in private (P < 0.001) and public hospitals (P > 0.05) was not significant. The waiting interval, beginning from the very moment of stepping into the ward until first examination and access to physical space of ED, was significant for private hospitals (P < 0.001) and insignificant for public hospitals (P > 0.05). According to the results, there was a direct correlation between access to physical space in ED and waiting time. In addition, improving the physical access did not necessarily result in shorter waiting time. Therefore, to improve triage process, improvement of waiting time indices, and modifying forms of work process in ED are recommended.
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ABSTRACT: Minor ailment attendances in general practices and emergency departments (EDs) place significant burden on health care resources. To estimate the prevalence and type of minor ailment consultations for adults in general practice and ED that could be managed in a community pharmacy. Retrospective review of routine data from general practices (n = 2) and one ED in North East Scotland. Two independent consensus panels assessed each consultation summary to determine whether it represented a minor ailment. Outcomes included prevalence of consultations for minor ailments in general practice and ED and frequency of different minor ailment type that could be managed in community pharmacies. In total, of the 494 general practice and 550 ED consultations assessed, 13.2% [95% confidence interval (CI): 18.6-25.9%] and 5.3% (95% CI: 4.0-8.0%), respectively, were categorized as minor ailments suitable for management in community pharmacies. Consensus among panel members was moderate for general practice consultations, but fair to poor for ED consultations. Agreement between uni- and multi-disciplinary panels was good. Applied to national data, these estimates would equate to ~18 million general practice and 6500000 ED consultations that could be redirected to community pharmacy, equating to ~£1.1 billion in resources. Minor ailment consultations still present a major burden on higher cost settings. Effective strategies are needed to raise awareness among patients and health professionals regarding conditions that can be managed effectively in pharmacies and to change patient health-seeking behaviour for such conditions. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
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