Funding: J. A. Lowthian was supported by a NHMRC Postgraduate Research Scholarship to undertake her doctorate in emergency demand.
Why older patients of lower clinical urgency choose to attend the emergency department
Article first published online: 17 JAN 2013
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 1, pages 59–65, January 2013
How to Cite
Lowthian, J. A., Smith, C., Stoelwinder, J. U., Smit, D. V., McNeil, J. J. and Cameron, P. A. (2013), Why older patients of lower clinical urgency choose to attend the emergency department. Internal Medicine Journal, 43: 59–65. doi: 10.1111/j.1445-5994.2012.02842.x
Conflict of interest: None.
- Issue published online: 17 JAN 2013
- Article first published online: 17 JAN 2013
- Accepted manuscript online: 30 MAY 2012 07:04AM EST
- Manuscript Accepted: 20 MAY 2012
- Manuscript Received: 26 NOV 2011
- emergency department;
- patient perspective;
To examine non-clinical factors associated with emergency department (ED) attendance by lower urgency older patients.
An exploratory descriptive study comprising structured interviews with lower urgency community-dwelling patients aged ≥70 years presenting to a tertiary metropolitan Melbourne public hospital ED. Demographical and clinical characteristics, self-reported feelings of social connectedness, perceived accessibility to primary care, reason for attending ED were measured.
One hundred patients were interviewed: mean age 82 years, 56% female, 57% lived alone; 73% presented during business hours, 58% arrived by ambulance, 80% presented for illness, and 65% were discharged home within 48 h. Fifty-six per cent of patients reported feeling socially disconnected, comprising 49% living alone compared with 65% who lived with their spouse/family. All patients attended a regular general practitioner, 31% reporting regular review appointments. Thirty-five per cent reported waiting times >2–3 days for urgent problems; 59% stated accessing care ‘after hours’ without attending ED as difficult, with 20% having attended ED 3–6 times in the previous 12 months. Reasons for attending ED were referral by a third party, difficulty with accessibility to primary care, patient preferences for timely care and fast-track access to specialist care.
Most older patients of lower clinical urgency presented to ED because of perceived access block to primary or specialist services, alongside an expectation of more timely and specialised care. This suggests that EDs should be redesigned and/or integrated community-based models of care developed to meet the specific needs of this age group who have growing demand for acute care.