title: New Zealand health professionals do not agree about what defines appropriate attendance at an emergency department.
abstract: OBJECTIVE
  Emergency Departments (EDs) worldwide are facing a crisis from overcrowding--a common perception exists that inappropriate use of the ED is the major contributing factor. This study aims to examine the concept of 'inappropriate' ED attendances in relation to the Emergency Department at New Zealand's Christchurch Hospital. It specifically seeks to determine whether there is a consensus opinion among healthcare providers regarding a definition of 'inappropriate'.
  
  
  METHODS
  An exploratory survey of health professionals involved with the referral, assessment, transport, and treatment of ED patients in Christchurch was carried out. A range of health professionals, including ambulance personnel, general practitioners, emergency department physicians, emergency nurses, and hospital managers were approached. A series of questions relating to definition and response to 'inappropriate' patients was asked, with an additional open-ended question relating to the definition of 'appropriateness'.
  
  
  RESULTS
  There are significant differences in the attitudes and perceptions of key health professionals involved in the referral, treatment, and admission of patients to the ED.
  
  
  CONCLUSIONS
  While there are some areas of general agreement, there is no clear consensus between the professionals surveyed regarding the concept of 'appropriateness.' This has implications for any interventions aimed at addressing ED 'overcrowding' that assume the presence of a consensus understanding of this concept.
authors.affiliation: Emergency Department, Christchurch Hospital, Christchurch. sandra.richardson@cdhb.govt.nz
authors.forename: Sandra
authors.initials: S
authors.lastname: Richardson
authors.forename: Michael
authors.initials: M
authors.lastname: Ardagh
authors.forename: Philip
authors.initials: P
authors.lastname: Hider
mesh_terms: D000328:Adult; D017677:Age Distribution; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D004635:Emergency Medicine / Q000706:statistics & numerical data; D016529:Emergency Nursing / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006740:Hospital Administrators / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009520:New Zealand; D012017:Referral and Consultation; D012938:Social Perception; D012959:Socioeconomic Factors