title: [Patients without referral treated in the emergency room: patient characteristics and motives].
abstract: OBJECTIVE
  To determine the motives of patients to directly visit the Emergency Department for medical treatment without seeing their family practitioner first and to establish the characteristics of this group.
  
  
  METHODS
  Prospective, descriptive.
  
  
  METHODS
  Of the surgical patients attending the Emergency Room (ER) of Utrecht University Hospital, the Netherlands, between 1st April and 25th June 1997, the demographic and diagnostic data of the non-referred patients were compared with those of patients referred by the general practitioner (GP). The non-referred patients were asked about their reasons to attend without referral.
  
  
  RESULTS
  A total of 1026 patients visited the ER at their own initiative: 603 males and 423 females. The most frequent reasons for the direct visits were 'had not thought of their family practitioner' (48%) and 'wants help that can only be provided in a hospital' (30%). The self-referring patients differed from the 962 referred patients in severity of the trauma: 76% versus 39% had a relatively minor trauma; sort of trauma: 19% versus 4% had a sport trauma; place of residence: 57% versus 45% lived in the near vicinity of the hospital. Of the self-referring patients 57% visited the hospital out of office hours, versus 39% of the referred patients.
  
  
  CONCLUSIONS
  A large part of the non-referred patients visited the ER unnecessarily and should actually have consulted their GP. These were mainly young adults with minor injuries or sports injuries who lived close to the hospital. Important factors were unfamiliarity with or lack of understanding of the existing regulations.
authors.affiliation: Academisch Ziekenhuis, Utrecht.
authors.forename: I
authors.initials: I
authors.lastname: Jaarsma-van Leeuwen
authors.forename: E R
authors.initials: ER
authors.lastname: Hammacher
authors.forename: R
authors.initials: R
authors.lastname: Hirsch
authors.forename: M
authors.initials: M
authors.lastname: Janssens
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors; D015599:Trauma Severity Indices; D014600:Utilization Review / Q000706:statistics & numerical data; D014947:Wounds and Injuries