Appropriateness of emergency department visits in a Turkish university hospital

To determine the patterns and appropriateness of patients' use of a university hospital emergency department.

During a 14-day period in November 1998, we collected demographic and socio-economic data, reasons for preferring emergency department care, and patient visit data from consecutive patients visiting our tertiary-care university hospital emergency department. The principle investigator reviewed the study information forms and classified visits according to the classification of Afilalo into three categories: category I--emergent emergency department visits; category II--needing evaluation within 6 hours, either in emergency department or elsewhere; or category III--needing evaluation after more than 6 hours. Three emergency medicine residency-trained physicians determined the appropriateness of emergency department evaluation. Patients in the categories II and III were retrospectively reclassified as appropriate or inappropriate, according to availability of care at the outpatient facility at the hour of initial emergency department presentation.

Complete data were collected from 1,155 (96.2%) of 1,201 patients visiting our emergency department during the study period. There were 69% (n=795) appropriate of visits. The mean stay at emergency department of inappropriate users lasted 66 min. The main reasons of inappropriate users to prefer emergency department care were its proximity, satisfaction with care, worsening symptoms, and unavailability of care in a regular clinic.

Although inappropriate emergency department usage was high, these patients had relatively short emergency department stays. The impact on emergency department resource utilization and "over-crowding" by these patients may not be as great as commonly perceived.