Non-urgent emergency department use: exploring patient characteristics in an urban and rural setting

The use of the emergency department for non-urgent healthcare has received considerable attention in international literature. People utilising the emergency department for non-urgent health problems have been referred to as ‘inappropriate’ users of the healthcare system, and it has been suggested that such use contributes to emergency department overcrowding, lengthy wait times, and decreased standards of care. However, there is a paucity of research examining this issue from a New Zealand perspective. Audit data from one District Health Board showed that differences in non-urgent attendance exist across an urban and rural setting, which raises important questions regarding factors precipitating such use, and how and why these differ based on emergency department location. This dissertation provides a ‘first look’ into the non-urgent use of the emergency department from a New Zealand perspective. The purpose of this study was to examine the demographic and clinical characteristics of individuals presenting to an urban and rural emergency department for non-urgent care, and to determine whether these characteristics differ based on ED location. The conceptual framework used in this study was Andersen’s Behavioural Model of Health Services’ Use. The model proposes that individual determinants, conceptualised as predisposing characteristics, enabling resources, and need collectively influence health utilisation behaviour. Using emergency department location as a grouping variable, this retrospective descriptive study examined the individual determinants of 4745 patients who sought non-urgent care between July 1 2009 and June 30 2010. The findings provide a comprehensive demographic and clinical overview of non-urgent attendees; significant differences (p = 0.001) were found in the characteristics of individuals seeking non-urgent care at the urban and rural emergency department with regard to age, ethnicity, time of presentation, season of presentation, distance to the emergency department, wait time for medical assessment, length of stay, referral source, presentation type, and discharge disposition. Further New Zealand based research is needed to explore possible interaction(s) between the predisposing, enabling, and need components of the model, and to identify the factors precipitating a non-urgent visit across the urban and rural setting