Emergency department crowding: why do patients walk-in?

Area of Science:

• Emergency Medicine
• Healthcare Management
• Patient Behavior Studies

Background:

• Emergency Department (ED) crowding is a persistent issue, often linked to general practitioner (GP) shortages and rising acute care demand.
• The increasing admission of non-emergency cases to EDs contributes significantly to overcrowding.
• Patient motivations for bypassing primary care and directly accessing EDs remain under-investigated.

Purpose of the Study:

• To investigate the primary reasons behind patients' self-referral to Emergency Departments (EDs) for acute care.
• To understand the decision-making process of patients choosing EDs over primary care services.
• To identify factors influencing ED attendance patterns.

Main Methods:

• A survey was administered to patients admitted to two university EDs over nine consecutive days.
• Patients reported their reasons for seeking care and whether they were self-referred or directed by a healthcare professional.
• Data collected included referral source (GP, specialist, emergency call) and self-reported motivations for ED visits.

Main Results:

• The majority of patients (68.0%) were self-referred to the ED.
• Key drivers for self-referral included perceived appropriateness of the ED for their condition (51.0%) and better accessibility (24.0%).
• Other factors influencing visits were seeking specialized care (15.0%), hospital reputation (4.6%), and stress (4.22%), with financial concerns being minimal (<1.0%).

Conclusions:

• Patients' perception of illness severity is the main driver for ED visits during acute care needs.
• Enhanced accessibility of EDs compared to other healthcare facilities significantly influences patient attendance.
• While hospital reputation and patient stress play minor roles, perceived severity and accessibility are paramount in ED utilization.