Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China; West China School of Nursing, West China Hospital, Sichuan University, China.
Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China.
Int Emerg Nurs. 2020 Sep;52:100845. doi: 10.1016/j.ienj.2020.100845. Epub 2020 Mar 20.
Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question.
This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns.
Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P < 0.05) and use of nearest medical institution (OR = 1.588, P < 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P < 0.01), type of health problems (OR = 1.641, P < 0.01) and self-rated health status (OR = 0.769, P < 0.01).
Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.
非紧急 ED 就诊是急诊过度拥挤的一个重要原因。先前的研究表明，患者因多种原因选择非紧急 ED 就诊，他们的 ED 使用模式可能受到多种因素的影响。然而，很少有研究是基于理论的，旨在对此问题提供系统的见解。
这是一项在中国一家三级医院的 ED 进行的横断面研究，以安德森健康服务使用行为模型为指导。对分诊为非紧急的患者进行了问卷调查，以调查他们 ED 就诊的原因以及影响他们 ED 使用模式的相关因素。
认为疾病严重程度和紧急治疗需求（374 例，68.6%）、可获得替代服务的问题（144 例，26.4%）和医务人员转诊（134 例，24.6%）是最常见的 ED 就诊原因。就诊前尝试替代服务由两个倾向因素决定：教育水平（OR=0.638，P<0.05）和使用最近的医疗机构（OR=1.588，P<0.05）。就诊前的非紧急 ED 使用由倾向因素和需要因素共同解释。它们是：国籍（OR=3.057，P<0.01）、健康问题类型（OR=1.641，P<0.01）和自我评估的健康状况（OR=0.769，P<0.01）。
尽管确定了一些因素，但患者对紧急护理的需求感知在推动 ED 使用方面起着至关重要的作用。未来旨在减少中国非紧急 ED 使用的研究可能首先从患者教育计划中取得成功。
