title: Why patients self-refer to the Emergency Department: A qualitative interview study.
abstract: OBJECTIVE
  There have been multiple studies investigating reasons for patients to self-refer to the Emergency Department (ED). The majority made use of questionnaires and excluded patients with urgent conditions. The goal of this qualitative study is to explore what motives patients have to self-refer to an ED, also including patients in urgent triage categories.
  
  
  METHODS
  In a large teaching hospital in the Netherlands, a qualitative interview study focusing on reasons for self-referring to the ED was performed. Self-referred patients were included until no new reasons for attending the ED were found. Exclusion criteria were as follows: not mentally able to be interviewed or not speaking Dutch. Patients who were in need of urgent care were treated first, before being asked to participate. Interviews followed a predefined topic guide. Practicing cyclic analysis, the interview topic guide was modified during the inclusion period. Interviews were recorded on an audio recorder, transcribed verbatim, and anonymized. Two investigators independently coded the information and combined the codes into meaningful clusters. Subsequently, these were categorized into themes to build a framework of reasons for self-referral to the ED. Characteristic quotes were used to illustrate the acquired theoretical framework.
  
  
  RESULTS
  Thirty self-referred patients were interviewed. Most of the participants were male (63%), with a mean age of 46 years. Two main themes emerged from the interviews that are pertinent to the patients' decisions to attend the ED: (1) health concerns and (2) practical issues.
  
  
  CONCLUSIONS
  This study found that there are 2 clearly distinctive reasons for self-referral to the ED: health concerns or practical motives. Self-referral because of practical motives is probably most suitable for strategies that aim to reduce inappropriate ED visits.
authors.affiliation: Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kraaijvanger
authors.affiliation: Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Douwe
authors.initials: D
authors.lastname: Rijpsma
authors.affiliation: Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Lisa
authors.initials: L
authors.lastname: Willink
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Lucassen
authors.affiliation: Intensive Care/Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: van Leeuwen
authors.affiliation: Surgery Department, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000706:statistics & numerical data; D036301:Qualitative Research; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Emergency Department; interviews; qualitative; self-referral