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August 14, 1996

Ambulatory Visits to Hospital Emergency Departments: Patterns and Reasons for Use

Author Affiliations

From the Department of Emergency Medicine, Highland General Hospital, Oakland, Calif, and the University of California at San Francisco (Drs Young and Ellis and Mr Bouley); the Division of Emergency Medicine, Beth Israel Hospital, Boston, Mass (Dr Wagner); and the Division of Emergency Medicine, Department of Surgery, Emory University, Atlanta, Ga (Dr Kellermann).

JAMA. 1996;276(6):460-465. doi:10.1001/jama.1996.03540060036032

Objectives.  —To characterize the reasons ambulatory patients use hospital emergency departments (EDs) for outpatient care and to determine the proportion of ED patients who initially are assessed as having nonurgent conditions, but subsequently are hospitalized.

Design.  —Cross-sectional survey during a single 24-hour period of time.

Setting.  —Fifty-six hospital EDs nationwide.

Patients or Other Participants.  —Consecutive ambulatory patients presenting for care. Patients who arrived by ambulance were excluded.

Results.  —Of 6441 ambulatory patients (79% of all ED visits) who were eligible for study, interviews were obtained from 6187 (96%). A total of 5323 patients (86%) had clinical reasons or preferences for seeking care at an ED, including 2799 (45%) who thought they had an emergency or an urgent condition or were too sick to go elsewhere. Nineteen percent (n=1199) reported that they were sent to the ED by a health care professional. Patients with a regular clinician or with insurance cited similar reasons for seeking care at an ED. A total of 3062 patients (50%) cited 1 or more nonfinancial barriers to care as an important reason for coming to the ED, and 949 (15%) cited financial considerations. A total of 3045 patients (49% of ambulatory patients and 37% of total ED visits) were assessed at triage as having a nonurgent condition; 166 of them (5.5%; 95% confidence interval, 4.7%-6.3%) were admitted to the hospital.

Conclusions.  —Most ambulatory patients seek care in an ED because of worrisome symptoms or nonfinancial barriers to care. Although many ambulatory patients appear to have nonurgent conditions based on triage classification, a small but disturbing percentage of nonurgent patients are hospitalized.