Use of the emergency department for nonurgent care during regular business hours

Objective: To characterize the patient population seeking care for nonurgent medical problems at an emergency department during regular business hours and to determine why these patients chose the emergency department over alternative care sites. Design: Patient survey (self-administered questionnaire). Setting: Emergency department at a tertiary care hospital in Montreal. Patients: All ambulatory patients presenting on weekdays between 8 am and 5 pm From Nov. 10 to Dec. 8, 1993, whose condition was determined to be nonurgent. Eligible patients had to be residents of Montreal who did not have a pre-arranged consultation at the emergency department. Of 202 consecutive eligible patients, 200 agreed to participate. Outcome measures: Description of events leading to the visit, including possible attempts by patients to contact their regular physician, patients' knowledge of alternative care options such as provincial CLSCs (centres locaux des services communautaires) and private walk-in clinics. Results: Of the 200 patients 152 (76%) stated that they had not visited an emergency department within the previous month, and only 10 (5%) stated that they were in extreme pain. At least 70% were aware of alternative care options; however, 120 (60%) felt that the emergency department was the bent place for them Co receive care for their medical problem. In all, 81 patients (40%) were referred to the emergency department; 62 (77%) were referred by a health care professional, 46 (57%) by a physician. Conclusion: Most patients are aware of alternatives to the emergency department for care of no medical problems. Nevertheless, a large number are being referred to the emergency department during regular business hours by health care professionals. This inefficient use of expensive hospital resources requires further investigation.