Original ContributionsAppropriateness of emergency department visits in a Portuguese University hospital☆,☆☆
Introduction
Overcrowding in public hospital emergency departments has become a major concern in developed countries.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 Inappropriate use of the ED for nonurgent problems has been suggested as a probable contributor to ED overcrowding1, 3, 5, 6, 7, 13, 14, 15, 16 and to an increase in health care costs.6, 13 The burden of inappropriate ED visits was estimated at different settings according to distinct criteria for determining the appropriateness of an ED visit.1, 12, 13, 17, 18 However, a generalization of these estimates is restricted by the lack of a universally accepted measurement of what constitutes an appropriate ED visit.1, 5, 12, 17, 18 As in other countries, factors for overcrowding in Portuguese EDs are assumed to be a consequence of inappropriate ED overuse.8 No studies in Portugal, at this time, have been concluded to support this assumption. The aim of this study was to determine the prevalence of appropriate ED visits in the setting of a major Oporto public teaching hospital and to assess factors associated with an appropriate ED visit.
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Materials and methods
This cross-sectional study was conducted between February and September 1998 in the ED of Hospital de São João, a public university hospital with approximately 220,000 adult (13 years and older) ED visits annually. It is one of two teaching hospitals in Oporto and a reference hospital for the acute medical or trauma patients.
A previous official report stated the prevalence of appropriate ED visits in Portugal to be 20%,8 with 80% of visits reported to be inappropriate. We thus used this
Results
Table 1 illustrates the patient profile based on the personal questionnaire.Characteristic No. (%)* Sex 5,818 (100.0) Male 2,829 (48.6) Female 2,989 (51.4) Age 5,818 (100.0) <60 y 4,393 (75.5) ≥60 y 1,425 (24.5) Employment 5,462 (93.9) Salaried work 2,687 (49.2) Unsalaried work 1,164 (21.3) Retired from work 1,331 (24.4) Unemployed 280 (5.1) Level of education 5,308 (91.2) Less than basic 1,074 (20.2) Basic education 2,603 (49.0) More than basic 1,631 (30.7)
Discussion
The ED at a public hospital is an essential part of the health care system because it provides care to all in need, especially those who are often unable to gain access to basic health services elsewhere.2, 3, 9, 13, 16, 18, 20, 21 However, in most US and European cities, EDs have become overcrowded,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 raising concern about their availability to give medical care for all who need it.2, 3, 4, 21 It has been shown that overcrowding in the ED prolongs waiting
Acknowledgements
We thank Rui Maio, lecturer of epidemiology in ICBAS, Oporto University, for his contribution to the statistical analysis.
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Cited by (0)
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Supported by grant No. 172/97 from the Comissão de Fomento da Investigação em Cuidados de Saúde.
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Address for reprints: António Oliveira e Silva, MD, Serviço de Medicina 2—Hospital de São João, Alameda Hernâni Monteiro, 4200, Porto, Portugal; 351-2-5025512, fax 351-2-5025512; E-mail [email protected] .