Judging a patient's decision to seek emergency healthcare: clues for managing increasing patient demand

Abstract

Objective. In recent years, the concept of an ‘inappropriate’ emergency department or ambulance user has arisen. This discussion paper explores definition and measurement of inappropriate emergency healthcare utilisation, and the effect on demand. Method. A comprehensive literature review of published articles was conducted. Results. Exploration of the definitions of ‘inappropriate’ emergency healthcare utilisation identified two patient cohorts; emergency healthcare utilisation by those who are not experiencing a health emergency, and those who do not seek emergency healthcare who should. Several position papers from Australian and international sources emphasised the patient’s right to access emergency healthcare when they feel the need, and the responsibility of emergency healthcare workers to provide treatment to all patients. Differences between medical classifications of urgency based on physiological measures are contrasted with patient-based determination of urgency, which is defined by psychosocial factors. Conclusions. This literature review raises questions about patients’ understanding of the role of emergency healthcare services in an emergency. This has implications for determining the patient’s point of access to the health system in an acute health event, and offers an opportunity to selectively educate patients and carers to change help-seeking behaviours to suit the health system resources and moderate patient demand. What is known about the topic? There is a public health issue where some patients seek emergency healthcare when they are not acutely unwell (inappropriate health service users) and some patients who fail to seek emergency healthcare when they are acutely unwell (patients who ‘delay’ or avoid using emergency health services). There is a difference in understanding between health professionals and patients about what a health emergency is and when it is appropriate to seek emergency healthcare. There is an increasing demand for emergency health services both nationally and internationally. What does this paper add? This paper provides a review of Australian and international rates of ‘inappropriate’ healthcare utilisation. This paper identifies the limitations on the ability to determine whether patients were appropriate or inappropriate, and instead identifies what motivates patients to seek emergency healthcare for non-acute events and fail to seek healthcare for acute events. What are the implications for practitioners? There is a high demand for health services, which is increasing, and understanding patient motivations to seek healthcare may assist the development of demand management strategies. This paper will enhance practitioner understanding of patient motivation to seek emergency healthcare. This paper concludes with educational information that practitioners can use to change patient healthcare utilisation patterns.