Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

<p>Abstract</p> <p>Background</p> <p>Overuse of emergency departments (ED) is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP) on call or the ED.</p> <p>Methods</p> <p>Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services.</p> <p>Results</p> <p>1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African) nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women.</p> <p>Conclusions</p> <p>Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.</p

Testing a classification model for emergency department errors

AIM: This paper presents an evaluation of the Eindhoven Classification Model for categorizing healthcare errors. BACKGROUND: The ability to decrease healthcare errors will depend on an understanding of the types and patterns of error that occur in variou

EMERGENCY DEPARTMENT PATIENTS WHO STAY MORE THAN 6 HOURS CONTRIBUTE TO CROWDING

BACKGROUND: Admitted and discharged patients with prolonged emergency department (ED) stays may contribute to crowding by utilizing beds and staff time that would otherwise be used for new patients. OBJECTIVES: To describe patients who stay \u3e 6 h in the ED and determine their association with measures of crowding. METHODS: This was a retrospective, observational study carried out over 1 year at a single, urban, academic ED. RESULTS: Of the 96,562 patients seen, 16,017 (17%) stayed \u3e 6 h (51% admitted). When there was at least one patient staying \u3e 6 h, 60% of the time there was at least one additional patient in the waiting room who could not be placed in an ED bed because none was open. The walk-out rate was 0.34 patients/hour when there were no patients staying in the ED \u3e 6 h, vs. 0.77 patients/hour walking out when there were patients staying \u3e 6 h in the ED (p \u3c 0.001). When the ED contained more than 3 patients staying \u3e 6 h, a trend was noted between increasing numbers of patients staying in the ED \u3e 6 h and the percentage of time the ED was on ambulance diversion (p = 0.011). CONCLUSION: In our ED, having both admitted and discharged patients staying \u3e 6 h is associated with crowding. Copyright 2010 Elsevier Inc. All rights reserved