Patient and provider perceptions of why patients seek care in emergency departments.
BACKGROUND
Little is known about why patients choose emergency departments (EDs) to receive care.


OBJECTIVE
Our aim was to measure the distribution and frequency of the stated reasons why patients choose the ED for care and why primary care physicians (PCPs) think their patients utilize the ED.


METHODS
The authors conducted a survey of patients presenting to an ED with 92,000 annual visits. Appropriate parametric tests were used for univariate and multivariate analysis and results were presented as frequencies with 95% confidence intervals. The authors also performed a cross-sectional survey of PCPs through a web-based survey.


RESULTS
Of the 1515 patients approached, 1083 (71%) agreed to participate and 1062 (98%) of them completed the survey. The most common reason patients gave for coming to the ED was their belief that their problem was serious (61%), followed by being referred (35%). In addition, 48% came at the advice of a provider, family member, or friend. By self-report, 354 (33%) patients attempted to reach their PCPs and 306 (86%) of them were successful. Two hundred and seventy-five PCPs were also surveyed. The most frequent reasons PCPs thought their patients came to an ED were that the patient chose to go on their own (80%) and the patients felt that they were too sick to be seen in the PCP's office (80%).


CONCLUSIONS
The majority of patients stated that the most common reason for seeking care in an ED was that they thought their problem was serious. Almost half sought ED care on the advice of a family member, friend, or health care provider, and a sizable minority were actually referred in by a health care provider. PCPs agree that most patients come to EDs because they believe they are too sick to be seen in their office or become sick after office hours.
Harvard Medical School and Harvard Business School, Boston, Massachusetts.
Lana
L
Lobachova
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
David F M
DF
Brown
Clinical Services, Brigham and Woman's Hospital, Boston, Massachusetts.
Julia
J
Sinclair
Department of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Yuchaio
Y
Chang
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Korie Zink
KZ
Thielker
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
John T
JT
Nagurney
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000368:Aged; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D062072:Patient Acuity; D010465:Perception; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult
emergency department; health-care−seeking behavior; overcrowding; referral; utilization