Motives for Self-referral to the Emergency Department: a Systematic Review of the Literature

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2016 Dec 13

PMID 27938366

Citations 32

Authors

Nicole Kraaijvanger

Henk van Leeuwen

Douwe Rijpsma

Michael Edwards

Affiliations

Soon will be listed here.

Abstract

Background: In several western countries patients' use of Emergency Departments (EDs) is increasing. A substantial number of patients is self-referred, but does not need emergency care. In order to have more influence on unnecessary self-referral, it is essential to know why patients visit the ED without referral. The goal of this systematic review therefore is to explore what motivates self-referred patients in those countries to visit the ED.

Methods: Recommendations from the PRISMA were used to search and analyze the literature. The following databases; PUBMED, MEDLINE, EMBASE, CINAHL and Cochrane Library, were systematically searched from inception up to the first of February 2015. The reference lists of the included articles were screened for additional relevant articles. All studies that reported on the motives of self-referred patients to visit an ED were selected. The reasons for self-referral were categorized into seven main themes: health concerns, expected investigations; convenience of the ED; lesser accessibility of primary care; no confidence in general practitioner/primary care; advice from others and financial considerations. A random-effects meta-analysis was performed.

Results: Thirty publications were identified from the literature studied. The most reported themes for self-referral were 'health concerns' and 'expected investigations': 36% (95% Confidence Interval 23-50%) and 35% (95% CI 20-51%) respectively. Financial considerations most often played a role in the United States with a reported percentage of 33% versus 4% in other countries (p < 0.001).

Conclusions: Worldwide, the most important reasons to self-refer to an ED are health concerns and expected investigations. Financial considerations mainly play a role in the United States.

Citing Articles

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Emergency care in Brazil: factors leading to clinically inappropriate use of emergency care among young adult users in the Brazilian context.

Mauch L, Sarti T, Madeira de Abreu K, Almeida A BMC Health Serv Res. 2024; 24(1):997.

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The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study.

Nau L, Laux G, Altiner A, Szecsenyi J, Leutgeb R JMIR Res Protoc. 2024; 13:e54002.

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[Motives of patients presenting independently at the emergency department-a prospective monocentric observational study].

Sitter K, Braunstein M, Wornle M Med Klin Intensivmed Notfmed. 2024; 119(7):546-557.

PMID: 38233669 PMC: 11461550. DOI: 10.1007/s00063-024-01106-2.

References

Munro J, Sampson F, Nicholl J . The impact of NHS Direct on the demand for out-of-hours primary and emergency care. Br J Gen Pract. 2005; 55(519):790-2. PMC: 1562344. View

Koziol-McLain J, Price D, Weiss B, Quinn A, Honigman B . Seeking care for nonurgent medical conditions in the emergency department: through the eyes of the patient. J Emerg Nurs. 2000; 26(6):554-63. DOI: 10.1067/men.2000.110904. View

Moll van Charante E, Ter Riet G, Bindels P . Self-referrals to the A&E department during out-of-hours: patients' motives and characteristics. Patient Educ Couns. 2007; 70(2):256-65. DOI: 10.1016/j.pec.2007.10.012. View

Stewart M, Savage J, Scott M, McClure B . Primary medical care in a paediatric accident and emergency department. Ulster Med J. 1989; 58(1):29-35. PMC: 2448563. View

Scott J, Conner D, Venohr I, Gade G, McKenzie M, Kramer A . Effectiveness of a group outpatient visit model for chronically ill older health maintenance organization members: a 2-year randomized trial of the cooperative health care clinic. J Am Geriatr Soc. 2004; 52(9):1463-70. DOI: 10.1111/j.1532-5415.2004.52408.x. View

Rettig B, Shrauger D, Recker R, Gallagher T, WILTSE H . A randomized study of the effects of a home diabetes education program. Diabetes Care. 1986; 9(2):173-8. DOI: 10.2337/diacare.9.2.173. View

Mian O, Pong R . Does better access to FPs decrease the likelihood of emergency department use? Results from the Primary Care Access Survey. Can Fam Physician. 2012; 58(11):e658-66. PMC: 3498040. View

Thijssen W, Wijnen-van Houts M, Koetsenruijter J, Giesen P, Wensing M . The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study. Emerg Med Int. 2013; 2013:364659. PMC: 3814098. DOI: 10.1155/2013/364659. View

OHalloran S, Heaf D . Recurrent accident and emergency department attendance for acute asthma in children. Thorax. 1989; 44(8):620-6. PMC: 461987. DOI: 10.1136/thx.44.8.620. View

10.

McGuigan T, Watson P . Non-urgent attendance at emergency departments. Emerg Nurse. 2010; 18(6):34-8. DOI: 10.7748/en.18.6.34.s18. View

11.

Singh S . Self referral to accident and emergency department: patients' perceptions. BMJ. 1988; 297(6657):1179-80. PMC: 1835022. DOI: 10.1136/bmj.297.6657.1179. View

12.

Rajpar S, Smith M, Cooke M . Study of choice between accident and emergency departments and general practice centres for out of hours primary care problems. J Accid Emerg Med. 2000; 17(1):18-21. PMC: 1756266. DOI: 10.1136/emj.17.1.18. View

13.

Grant R, Ramgoolam A, Betz R, Ruttner L, Green J . Challenges to accessing pediatric health care in the Mississippi delta: a survey of emergency department patients seeking nonemergency care. J Prim Care Community Health. 2013; 1(3):152-7. DOI: 10.1177/2150131910380727. View

14.

McWilliams D, Jacobson R, Van Houten H, Naessens J, Ytterberg K . A program of anticipatory guidance for the prevention of emergency department visits for ear pain. Arch Pediatr Adolesc Med. 2008; 162(2):151-6. DOI: 10.1001/archpediatrics.2007.30. View

15.

THOMSON H, Kohli H, Brookes M . Non-emergency attenders at a district general hospital accident and emergency department. J Accid Emerg Med. 1995; 12(4):279-81. PMC: 1342581. DOI: 10.1136/emj.12.4.279. View

16.

Shah N, Shah M, Behbehani J . Predictors of non-urgent utilization of hospital emergency services in Kuwait. Soc Sci Med. 1996; 42(9):1313-23. DOI: 10.1016/0277-9536(95)00233-2. View

17.

Rassin M, Nasie A, Bechor Y, Weiss G, Silner D . The characteristics of self-referrals to ER for non-urgent conditions and comparison of urgency evaluation between patients and nurses. Accid Emerg Nurs. 2005; 14(1):20-6. DOI: 10.1016/j.aaen.2005.10.003. View

18.

Hammacher E, Hirsch R, Janssens M . [Patients without referral treated in the emergency room: patient characteristics and motives]. Ned Tijdschr Geneeskd. 2000; 144(9):428-31. View

19.

Ragin D, Hwang U, Cydulka R, Holson D, Haley Jr L, Richards C . Reasons for using the emergency department: results of the EMPATH Study. Acad Emerg Med. 2005; 12(12):1158-66. DOI: 10.1197/j.aem.2005.06.030. View

20.

MESTITZ P . A series of 1,817 patients seen in a casualty department. Br Med J. 1957; 2(5053):1108-9. PMC: 1962725. DOI: 10.1136/bmj.2.5053.1108. View