title: Why do patients self-present to Middlemore Hospital Emergency Department?
abstract: OBJECTIVE
  To determine the drivers for acute (Australasian Triage Scale Category 3-5) demand in patients who self-present to New Zealand's Middlemore Hospital Emergency Department (MMH ED), we sought to establish a demographic profile of a sample of self-presenting patients and explore their reasons for presenting to ED rather than attending a primary care centre.
  
  
  METHODS
  A prospective, observational study was undertaken of patients in Australasian Triage Scale Categories 3-5 (ATS 3-5) who self-presented to MMH ED over a 7 day period from 14 April 2011 to 21 April 2011. We studied two time periods, 0900-1200 and 1800-2200, to compare drivers for attendance to MMH ED during primary care service open hours and closed hours. A structured questionnaire was used to collect demographic data and outcomes. The cumulative 2011 demographic data for self-presentations to MMH was compared to the study data.
  
  
  RESULTS
  500 patients were approached to participate and 421 met the inclusion criteria. The mean age of presenters was 37.6 years (SD of 24.6) with 48.2% (95%CI 44-53%) being male and 23% (95%CI 19-27%) employed. Of those who indicated they had a general practitioner (GP), 23% (95%CI 21-30%) had contacted their GP prior to presentation to MMH ED, with 73% (n=73) advised to attend ED. Of the 73 patients told by their GP to attend ED, 30 (41.1%; 95%CI 31-53%) were admitted, with two patients being transferred to another district health board (DHB), and the remainder discharged home. Thirty-two percent of the self-presenting patients came to ED because they felt sick enough to require emergency care. Comparison of the data for the two time periods indicated only one significant difference: 14% of patients presented to ED in the morning because their GP was closed, whereas 28.7% of those who presented after hours did so for this reason.
  
  
  CONCLUSIONS
  Almost 25% of self-presenting patients had contacted their GP or a health professional prior to their ED presentation and were advised to attend ED. The most common reason for patients to self-present at MMH ED is the belief that a hospital emergency department is the appropriate service to treat acute sickness. Neither cost nor knowledge of the Shorter Stays in Emergency Departments Health Target featured as a reason for attendance.
authors.affiliation: Emergency Department, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand. vthornton@middlemore.co.nz.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Thornton
authors.forename: Annie
authors.initials: A
authors.lastname: Fogarty
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Nouran
authors.initials: N
authors.lastname: Ragaban
authors.forename: Catherine
authors.initials: C
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003657:Decision Making; D059026:Diagnostic Self Evaluation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D057240:Patient Preference / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D014218:Triage; D055815:Young Adult