Journal review

Koziol-McLain J, Price DW, Weiss B, et al. Seeking care for nonurgent medical conditions in the emergency department: Through the eyes of a patient. J Emerg Nurs 2000; 26:554-563.

Patients seeking ED care for nonurgent medical diagnoses did not perceive themselves as having an urgent problem, according to this study. The patients typically had been unsuccessful in gaining access to alternative non-ED health care settings and went to the ED as a result, say the study’s findings.

This finding has important implications for care delivery, say the researchers. They argue that the goal of shifting nonurgent visits from the ED to other health care settings does not consider the patient’s perspective. They write: "Uninsured patients’ reasons for seeking care in the emergency department are far more complex than can be conveyed by a medical chief complaint or diagnostic label."

Here are some of the reasons discovered by the researchers:

• Patients "tough it out" before deciding to seek care at the ED.
• Patients make decisions to seek care by consulting friends and relatives.
• Patients may decide to seek care because of worsening symptoms and their effect on work and sleep.
• Work schedules and transportation barriers have an impact on a patient’s decision to seek care.
• Patients may try to access nonemergency care settings before they go to the ED.

The study demonstrated the existence of other issues in the lives of uninsured patients who seek help for a nonemergency problem in the ED. "For some persons, familial and social relationships [have] been disrupted. For others, distress was related to physiologic health, spiritual health, or social support," they wrote. "The ED visit was, in many ways, like sending out a distress call."