|
Article Excerpt
ABSTRACT
Purpose: To discover what motivates patients to seek emergency department (ED) care through their definition of a medical emergency.
Design and Methods: A qualitative design using a general inductive approach was conducted with 55 patients at three southeastern EDs. Triangulation of data collection was achieved through the completion of observational notes, demographics form, medical scenarios and symptoms form, and semi-structured interviews which were tape recorded. The interviews focused on patients' definition of a medical emergency.
Findings: Overwhelmingly, patients related pain as a medical emergency though many different aspects of pain emerged such as severity, unrelenting, fear of serious illness, and immediate need for care. Additionally, patients responded with the following definitions of a medical emergency: something life threatening, the need for urgent or quick care, the need for medical assistance, and inability to see primary care provider.
Conclusions: Patients perceive a broad and ill-defined perception of a medical emergency, which has developed from patients' past medical and family experiences. Patients have a broad, colloquial understanding of a medical emergency and perceive an emergency based on their personal understanding of the medical condition present.
Patients seek ED care for health care providers' medical expertise and knowledge of treatment options. Patients must understand basic medical conditions and treatment options in order to decipher the correct use of the ED.
Introduction
Discovering the Patient's Definition of a Medical Emergency
In 2004, the National Hospital Ambulatory Medical Care Survey (NHAMCS) reported an estimated 110.2 million annual emergency department (ED) visits, an 18% increase since 1994 (McCraig & Nawar, 2006). The increase usage of the ED has led to its overuse and misuse, where as many as 75% of patients present with non-urgent symptoms (Young, Wagner, Kellerman, Ellis, & Bouley, 1996; Billings, Parikh, & Mijanovich, 2000). The dramatic increase in ED utilization during the past decade is a complex issue with numerous contributing factors. A significant contributing factor is the convenience of ED care, including continuous hours of operation, geographical location and no appointment necessary for evaluation (Ragin et al., 2005). Additional reasons include access, need, referral, familiarity and trust, all which influence patients to choose emergency medicine (Afilalo et al., 2004).
The increase in ED use has led to ED overcrowding which has many negative effects on the patients, health care providers, and hospitals. Overcrowding is an international concern that is common in North America, United Kingdom, and Australia (Sprivulis et al, 2006; Trzeciak & Rivers, 2003). Negative effects include: increased patient mortality (Sprivulis, Da Silva, Jacobs, Frazer, & Jelinek, 2006; Richardson, 2006), reduced quality of care (Trzeciak & Rivers, 2003), delay of necessary treatments such as pain medications (Derlet & Richards, 2000), antibiotic administration (Shah, Schmit, Croley, & Meltzer, 2003), and patients' unnecessary exposure to nosocomial infections (Shah et al., 2003).
Many programs and proactive measures have been developed in order to decrease patient usage of the ED such as patient education (Powell & Breedlove-Williams, 1995), telephone triage (LaFrance & Leduc, 2002), access to office appointments (Davidson, Giancola, Gast, Ho, & Wadell, 2003; Cunningham, 2006), pre-authorization (Franco, Mitchell, & Buzon, 1997; Young & Lowe, 1997), and increased insurance co-payment (Cunningham, 2006), which have only produced...
|
