Objectives: The increasing number of low-acuity visits to emergency
departments (ED) is an important issue in Germany, despite the fact that all
costs of inpatient and outpatient treatment are covered by mandatory health
insurance. We aimed to explore the motives of patients categorised with low-
acuity conditions for visiting an ED. Methods: We conducted a qualitative
study in two urban and one rural ED. We recruited a purposive sample of
adults, who were assigned to the lowest two categories in the Manchester
triage system. One-to-one interviews took place in the ED during patients'
waiting time for treatment. Interview transcripts were analysed using the
qualitative data management software MAXQDA. A qualitative content analysis
approach was taken to identify motives and to compare the rural with the urban
sites. Results: A total of 86 patients were asked to participate; of these,
n=15 declined participation and n=7 were excluded because they were admitted
as inpatients, leaving a final sample of 40 female and 24 male patients. We
identified three pathways leading to an ED visit: (1) without primary care
contact, (2) after unsuccessful attempts to see a resident specialist or
general practitioner (GP) and (3) recommendation to visit the ED by an
outpatient provider. The two essential motives were (1) convenience and (2)
health anxiety, triggered by time constraints and focused usage of
multidisciplinary medical care in a highly equipped setting. All participants
from the rural region were connected to a GP, whom they saw more or less
regularly, while more interviewees from the urban site did not have a
permanent GP. Still, motives to visit the ED were in general the same.
Conclusions: We conclude that the ED plays a pivotal role in ambulatory acute
care which needs to be recognised for adequate resource allocation. Trial
registration number: DRK S0000605
