Stube Charles W, Ljungberg Alexander S, Borton Jason A, Chadha Kunal, Kelleran Kyle J, Lerner E Brooke
University at Buffalo, Department of Emergency Medicine, Buffalo, New York.
University at Buffalo, Department of Pediatrics, Buffalo, New York.
West J Emerg Med. 2024 Nov;25(6):921-928. doi: 10.5811/westjem.18647.
There are several options for receiving acute care besides emergency departments (ED), such as primary care physician (PCP) offices, urgent care centers (UCC), and telehealth services. It is unknown whether these alternative modes of care have decreased the number of ED visits for patients or whether they are considered before visiting the ED. A comprehensive study considering all potential methods of care is needed to address the evolving landscape of healthcare. Our goal was to identify any factors or barriers that may have influenced a patient's choice to visit the ED as opposed to a UCC, PCP, another local ED, or use telehealth services.
We surveyed ED patients between three hospital sites in the greater Buffalo, NY, area. The survey consisted of questions regarding the patients' reasons and rationale for choosing the ED over the alternative care options. The study also involved a health record review of the patients' diagnoses, tests/procedures, consults, and final disposition after completion of the survey.
Of the 590 patients consented and surveyed, 152 (25.7%) considered seeking care at a UCC, 18 (3.1%) considered telehealth services, and 146 (24.7%) attempted to contact their PCP. On the recommendation of their PCP, patients presented to the ED 110 (20.7%) times and on the recommendation of the clinician at the UCC 54 (9.2%) times. Patients' perceived seriousness of their condition was the most common reason for their selected mode of transport to the ED and reason for choosing the ED as opposed to alternative care sites (PCP, UCC, telehealth). Based on criteria for an avoidable ED visit, 83 (14.1%) ED patients met these criteria.
Individuals prioritize the perceived severity of their condition when deciding where to seek emergency care. While some considered alternatives (PCP, UCC, telehealth services), uncertainties about their condition and recommendations from other clinicians led many to opt for ED care. Our findings suggest a potential gap in understanding the severity of symptoms and determining the most suitable place to seek medical care for these particular conditions.
除了急诊科（ED）之外，还有几种获得急性护理的途径，例如初级保健医生（PCP）办公室、紧急护理中心（UCC）和远程医疗服务。尚不清楚这些替代护理模式是否减少了患者的急诊就诊次数，或者在前往急诊科就诊之前是否会考虑这些模式。需要进行一项全面研究，考虑所有潜在的护理方法，以应对不断变化的医疗保健格局。我们的目标是确定可能影响患者选择前往急诊科而非紧急护理中心、初级保健医生处、另一家当地急诊科或使用远程医疗服务的任何因素或障碍。
我们对纽约州布法罗市大区三个医院站点的急诊科患者进行了调查。该调查包括有关患者选择急诊科而非替代护理选项的原因和理由的问题。该研究还涉及在调查完成后对患者的诊断、检查/程序、会诊和最终处置进行健康记录审查。
在590名同意参与调查的患者中，152名（25.7%）考虑在紧急护理中心寻求护理，18名（3.1%）考虑使用远程医疗服务，146名（24.7%）试图联系他们的初级保健医生。在初级保健医生的建议下，患者前往急诊科就诊110次（20.7%），在紧急护理中心临床医生的建议下就诊54次（9.2%）。患者对自身病情严重程度的认知是他们选择前往急诊科的最常见交通方式的原因，也是选择急诊科而非替代护理地点（初级保健医生、紧急护理中心、远程医疗）的原因。根据可避免的急诊就诊标准，83名（14.1%）急诊科患者符合这些标准。
个人在决定何处寻求紧急护理时会优先考虑他们对自身病情严重程度的认知。虽然有些人考虑了替代选项（初级保健医生、紧急护理中心、远程医疗服务），但对自身病情的不确定性以及其他临床医生的建议导致许多人选择了急诊科护理。我们的研究结果表明，在理解症状严重程度以及确定针对这些特定病情寻求医疗护理的最合适地点方面可能存在差距。
