Emergency outpatient services in the city of Berlin: Factors for appropriate use and predictors for hospital admission.
OBJECTIVE
To determine the proportion of patients making inappropriate use of medical care at hospital emergency rooms. To identify the factors that influence appropriateness of use and the probability of subsequent hospital admission.


METHODS
Data were collected from 815 patients at three gynaecological/internal medicine emergency clinics in Berlin, Germany using multiple data sources: (i) standardized interviews covered service use history, psychosocial variables, migration history and sociodemographics; (ii) medical data were retrieved from patients' medical records, including case histories, diagnoses and therapies; (iii) emergency room physicians were asked to evaluate patients' language comprehension, physician-patient relationship and treatment urgency. Statistical analyses included chi tests, correlational and logistic regression analyses.


RESULTS
According to a self-constructed index measuring appropriateness of emergency service use, about half of the patients' visits would have to be classified as inappropriate. Age, chronic illness and the time of day of the emergency service attendance were significantly associated with appropriateness of use. The probability of a hospital admission following the emergency treatment increased with patients' age and the physician's evaluation of treatment urgency. Remarkably, and contrary to the results of international studies, the patient's ethnicity played no significant role with respect to the appropriateness of use of emergency outpatient services or the likelihood of subsequent hospital admission.
David
Matthias
M
Clinic for Gynecology and Obstetrics, Charité-University Medical School, Berlin, Virchow Campus, Berlin, Germany. matthias.david@charite.de
Schwartau
Imke
I
Anand Pant
Hans
H
Borde
Theda
T
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000523:psychology / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D001604:Berlin; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000523:psychology / Q000706:statistics & numerical data*; D004641:Emigration and Immigration; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014421:Turkey / Q000208:ethnology