Emergency department visits for non-life-threatening conditions: evolution over 13 years in a Swiss urban teaching hospital

Abstract

INTRODUCTION: A large proportion of visits to our Emergency Department (ED) are for non-life-threatening conditions. We investigated whether patients’ characteristics and reasons for consultation had changed over 13 years. METHODS: Consecutive adult patients with non-life-threatening conditions at triage were included in the spring of 2000 and in the summer of 2013. In both years patients completed a similar questionnaire, which addressed their reasons for consultation and any previous consultation with a general practitioner (GP). RESULTS: We included 581 patients in 2013 vs 516 in 2000, with a mean age of 44.5 years vs 46.4 years (p = 0.128). Of these patients, 54.0% vs 57.0% were male (p = 0.329), 55.5% vs 58.7% were Swiss (p = 0.282), 76.4% were registered with a GP in both periods, but self-referral increased from 52.0% to 68.8% (p <0.001); 57.7% vs., 58.3% consulted during out-of- hours (p = 0.821). Trauma-related visits decreased from 34.2% to 23.7% (p <0.001). Consultations within 12 hours of onset of symptoms dropped from 54.5% to 30.9%, and delays of ≥1 week increased from 14.3% to 26.9% (p <0.001). The primary motive for self-referral remained unawareness of an alternative, followed in 2013 by dissatisfaction with the GP’s treatment or appointment. Patients who believed that their health problem would not require hospitalisation increased from 52.8% to 74.2% and those who were actually hospitalised decreased from 24.9% to 13.9% (all p <0.001). CONCLUSION: The number of visits for non-life-threatening consultations continue to increase. Our ED is used by a large proportion of patients as a convenient alternative source of primary care.

Keywords

• questionnaire
• emergency department
• primary care
• Emergency care
• non-urgent