Patients' pathway to emergency care:  is the emergency department their first choice of care?
OBJECTIVE
To investigate whether patients came directly to the emergency department (ED) or whether they had taken any other actions or activities within the healthcare system before attending the ED. An additional aim was to increase our understanding of the potential determinants between patients' ED-seeking behaviour and patient-related data.


METHODS
This prospective descriptive study was carried out at the ED at a level one trauma centre at a university hospital in Sweden. During 12 weeks in 2008, a 20-item study-specific questionnaire was distributed by research assistants to patients arriving either by their own means or by ambulance to the ED. In addition, patient-specific data were gathered from the electronic patient records.


RESULTS
A total of 2014 patients participated in the study, of whom 1192 (59%) reported to have carried out healthcare-related actions or activities before their visit to the ED. A general practitioner was the most common (29.1%) healthcare provider to have been in contact with. Female patients and patients with a longer duration of symptoms sought other health caregivers before the ED visit to a significantly higher extent (P<0.001, 0.003). Other caregivers' referral rate to the ED was 60.1-87.9%. Accessibility to other caregivers was generally rated as easy.


CONCLUSIONS
A large proportion of ED patients sought previous healthcare before seeking care at the ED. Female patients and patients with longer symptom duration more often sought other caregivers before seeking ED care.
Department of Emergency Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. katarina.goransson@karolinska.se
Katarina E
KE
Göransson
Michaela
M
De Waern
Per
P
Lindmarker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D002755:Choice Behavior; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D055815:Young Adult