Patient perspectives on emergency department self-referral.

Introduction: Reducing avoidable emergency department (ED) visits is an increasingly important target of quality improvement efforts in bariatric surgery. Administrative and clinical registry data provides an incomplete picture of the factors contributing to post-operative ED utilization among bariatric surgery patients. Patient and provider interviews are an important tool to complement this data and understand the root causes of non-urgent ED self-referral. Patient centered interviews can help identify intervention opportunities through the examination of utilization trends. We sought to understand the circumstances surrounding patient self-referral to the emergency department after elective, primary bariatric surgery. Methods: A retrospective review of clinically abstracted data and patient interviews was completed across 39 hospitals participating in a statewide quality improvement collaborative. Trained nurses collected data on the circumstances surrounding patient\u27s 30-day post-operative ED visits utilizing a previously validated interview tool. Patients were interviewed if their ED visit was bariatric related, they had not contacted their surgical team prior to their visit, and they were not readmitted. Over a 10-month period, 141 patients out of 432 total ED visits met the inclusion criterion, with 100% of those patients being interviewed. Results: The most common patient chief complaints were abdominal pain, nausea/vomiting, and chest pain with rates of 35%, 26%, and 12%, respectively. 60% of patients were treated with IV fluids, 38% with pain control medicine, and 35% with anti-emetics. 61% of patients visited the ED during a weekday, and 77% reported their visit occurring outside of traditional office hours. Patients reported high compliance (490%) with provider driven perioperative measures aimed at reducing readmissions and ED visits. 70% of patients said they did not seek any alternatives prior to their ED visit. Most patients reported no knowledge of or guidance in the use of alternative care settings such as urgent care clinics or infusion centers. Conclusions: Most patients experienced non-life threatening symptoms, but believed their concerns required immediate medical attention in an ED. Patients who self-referred to the ED did not seek care alternatives despite the increasing availability of these options. Urgent care centers are a practical alternative to the ED for patients who elect not to contact their surgical team, but require prompt medical attention. Providing focused, patient-centered education on appropriate alternative care options available to patients experiencing non-life threatening symptoms may decrease inappropriate ED utilization among post-operative bariatric patients