Identification of low-acuity attendances in routine clinical information documented in German Emergency Departments

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Abstract

Introduction

It has not yet been possible to ascertain the exact proportion, characterization or impact of low-acuity emergency department (ED) attendances on the German Health Care System since valid and robust definitions to be applied in German ED routine data are missing.

Methods

Internationally used methods and parameters to identify low-acuity ED attendances were identified, analyzed and then applied to routine ED data from two EDs of the tertiary care hospitals Charité—Universitätsmedizin Berlin, Campus Mitte (CCM) and Campus Virchow (CVK).

Results

Based on the three routinely available parameters `disposition´, `transport to the ED´ and `triage´ 33.2% ( n = 30 676) out of 92 477 presentations to the two EDs of Charité—Universitätsmedizin Berlin (CVK, CCM) in 2016 could be classified as low-acuity presentations.

Conclusion

This study provides a reliable and replicable means of retrospective identification and quantification of low-acuity attendances in German ED routine data. This enables both intra-national and international comparisons of figures across future studies and health care monitoring.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-023-00838-2.

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Most cited references 52

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Emergency department visits for nonurgent conditions: systematic literature review.

Lori Uscher-Pines, Jesse M. Pines, Arthur Kellermann … (2013)

A large proportion of all emergency department (ED) visits in the United States are for nonurgent conditions. Use of the ED for nonurgent conditions may lead to excessive healthcare spending, unnecessary testing and treatment, and weaker patient-primary care provider relationships.

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Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Joanne E Coster, Janette K Turner, Daniel Bradbury … (2017)

Abstract Objectives Rising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care. Methods Systematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer‐reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework‐based narrative synthesis. Results Thirty‐eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty‐nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency‐based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations. Conclusions We identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.

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Increase in patient mortality at 10 days associated with emergency department overcrowding.

Drew B Richardson (2006)

To quantify any relationship between emergency department (ED) overcrowding and 10-day patient mortality. Retrospective stratified cohort analysis of three 48-week periods in a tertiary mixed ED in 2002-2004. Mean "occupancy" (a measure of overcrowding based on number of patients receiving treatment) was calculated for 8-hour shifts and for 12-week periods. The shifts of each type in the highest quartile of occupancy were classified as overcrowded. All presentations of patients (except those arriving by interstate ambulance) during "overcrowded" (OC) shifts and during an equivalent number of "not overcrowded" (NOC) shifts (same shift, weekday and period). In-hospital death of a patient recorded within 10 days of the most recent ED presentation. There were 34 377 OC and 32 231 NOC presentations (736 shifts each); the presenting patients were well matched for age and sex. Mean occupancy was 21.6 on OC shifts and 16.4 on NOC shifts. There were 144 deaths in the OC cohort and 101 in the NOC cohort (0.42% and 0.31%, respectively; P=0.025). The relative risk of death at 10 days was 1.34 (95% CI, 1.04-1.72). Subgroup analysis showed that, in the OC cohort, there were more presentations in more urgent triage categories, decreased treatment performance by standard measures, and a higher mortality rate by triage category. In this hospital, presentation during high ED occupancy was associated with increased in-hospital mortality at 10 days, after controlling for seasonal, shift, and day of the week effects. The magnitude of the effect is about 13 deaths per year. Further studies are warranted.

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Author and article information

Contributors

Antje Fischer-Rosinský: antje.fischer-rosinsky@charite.de

Journal

Journal ID (nlm-ta): BMC Emerg Med

Journal ID (iso-abbrev): BMC Emerg Med

Title: BMC Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-227X

Publication date (Electronic): 6 June 2023

Publication date PMC-release: 6 June 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 64

Affiliations

GRID grid.6363.0, ISNI 0000 0001 2218 4662, Emergency and Acute Medicine (CVK, CCM), , Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, ; Augustenburger Platz 1, 13353 Berlin, Germany

Article

Publisher ID: 838

DOI: 10.1186/s12873-023-00838-2

PMC ID: 10243890

PubMed ID: 37280527

SO-VID: b779d2a4-da03-4417-9d8b-e5e883a8eba9

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 November 2022

Date accepted : 31 May 2023

Funding

Funded by: Charité - Universitätsmedizin Berlin (3093)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: utilization,avoidable,low-urgent,non-urgent,emergency department,primary care treatable,general practitioner treatable,routine data

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: utilization, avoidable, low-urgent, non-urgent, emergency department, primary care treatable, general practitioner treatable, routine data

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Identification of low-acuity attendances in routine clinical information documented in German Emergency Departments

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Abstract

Introduction

Methods

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Conclusion

Supplementary Information

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Preventive and Emergency Medicine Insights

Most cited references 52

Emergency department visits for nonurgent conditions: systematic literature review.

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis

Increase in patient mortality at 10 days associated with emergency department overcrowding.

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