Why Do Patients Opt for the Emergency Department over Other Care Choices? A Multi-Hospital Analysis

Area of Science:

• Emergency Medicine
• Healthcare Access
• Patient Behavior

Background:

• Alternative acute care options like primary care physician (PCP) offices, urgent care centers (UCC), and telehealth exist alongside emergency departments (ED).
• It remains unclear if these alternatives reduce ED visits or are considered prior to ED utilization.
• A comprehensive understanding of patient decision-making in acute care settings is needed.

Purpose of the Study:

• To identify factors and barriers influencing patient choices to visit the ED over alternative care options (UCC, PCP, telehealth).

Main Methods:

• A survey of ED patients across three hospital sites in the greater Buffalo, NY area.
• Questions focused on patients' reasons and rationale for selecting the ED.
• Health record review including diagnoses, tests, consults, and disposition.

Main Results:

• Of 590 surveyed patients, 25.7% considered UCC, 3.1% telehealth, and 24.7% attempted PCP contact.
• PCP and UCC clinician recommendations led to ED visits in 20.7% and 9.2% of cases, respectively.
• Perceived condition severity was the primary driver for ED choice; 14.1% of visits met criteria for being avoidable.

Conclusions:

• Patients prioritize perceived condition severity when selecting emergency care, often opting for the ED even after considering alternatives.
• Uncertainty about condition severity and clinician recommendations contribute to ED utilization.
• Findings indicate a potential gap in patient understanding of symptom severity and appropriate care-seeking locations.