Abstract:
AIM: 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. METHOD: 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. CONCLUSION: 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.