Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care
Abstract
:1. Introduction
Definition of a Consultation not Requiring a Medical Emergency Department Level of Care
2. Methods
2.1. Study Design
2.2. Objectives
- Establish whether CIMU 5 patients could be reoriented by the TN towards their PCP without an ED physician consultation;
- Assess post-ED consultation satisfaction.
2.3. Population
- Age > 18 years;
- Beneficiary of social security;
- French or English speaking and writing;
- French resident;
- Spontaneously coming to consult at the emergency department; in other words, not having been sent to the ED by the 112 emergency hotline, another physician, or brought to the ED by any first responder (police, fire department, military);
- Categorized as CIMU 5.
- Having been asked back by the ED (systematic follow-up, clinical deterioration);
- Unable to write (for example, due to trauma);
- Vulnerable or marginalized members of the population (homeless, refugees, migrants, undocumented migrants, etc.);
- Presenting with a nonmedical issue;
- Having refused to participate in the study;
- Having answered the survey but having left without having been seen by the ED physician;
- Not categorized as CIMU 5 (in case of survey given to the wrong patient);
- Other cases (inaccurate history).
2.4. Questionnaire
2.5. Data Collection
2.6. Flow Chart
2.7. Outcomes and Study Variables
2.8. Statistics
2.9. Ethics
3. Results
3.1. CIMU 5 Patient Characteristics
3.2. Patient Flow Paths
3.3. Complaints Justifying the Consultations
3.4. Care provided at the ED
4. Discussion
4.1. Profile and Flow Path of Patients Manageable by General Practice Consultations
4.2. What Solutions Could Be Feasible to Optimally Offer Care for These Patients?
4.3. Limits
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Consent to Publish
Availability of Data and Material
Abbreviations
CCMU | French clinical emergency department classification (Classification Clinique des Malades aux Urgences) |
CIMU | French Emergency Nurses Classification in Hospital scale, CIMU (Classification Infirmière des Malades aux Urgences) |
ED | emergency department |
ENT | ear, nose, and throat |
PCP | primary care provider |
SFMU | French Emergency Medicine Society |
TN | triage nurse |
Appendix A. The French Emergency Nurses Classification in Hospital scale, Classification Infirmière des Malades aux Urgences (CIMU)
Triage | Description | Action |
1 | Immediately life-threatening. | Actions focused on support of one or more vital functions. Immediate medical and paramedical intervention. |
2 | Marked impairment of a vital organ or imminently life-threatening or functionally disabling traumatic lesion. | Actions focused on treatment of the vital function or traumatic lesion. Immediate paramedical and medical intervention within 20 min. |
3 | Functional impairment or organic lesions likely to deteriorate within 24 h or complex medical situation justifying the use of several hospital resources. | Multiple actions focused on diagnostic evaluation and prognostic evaluation in addition to treatment. Medical intervention within 60 min ± followed by paramedical intervention. |
4 | Stable, noncomplex functional impairment or organic lesions, but justifying the urgent use of at least one hospital resource. | Consult with limited diagnostic or therapeutic procedures. Medical intervention within 120 min ± followed by paramedical intervention. |
5 | No functional impairment or organic lesion justifying the use of hospital resources. | Consult with no diagnostic or therapeutic procedure. Medical intervention within 240 min. |
* | Intense symptom or abnormal vital parameter justifying rapid corrective action. | Specific action within 20 min. The star can complete a triage 3 or 4. |
Appendix B. Survey Distributed to the Included CIMU 5 Patients
Family name: _____________________________________ | ||
First name: _____________________________________ | ||
Sex: ▯ Female ▯ Male | ||
Birthday: | ___ / ___ / ______ | |
Phone: | __ __ __ __ __ | |
City/Town of residence: | ____________________________ |
- ▯
- Social security insurance
- ▯
- Complementary health coverage
- ▯
- Special social security (CMU, AME)
- ▯
- None
- ▯
- Yes, in which city is your GP? ________________________
- ▯
- No
- ▯
- Farmer, agricultural worker
- ▯
- Craftsman, merchant, manager
- ▯
- Executive, intellectual profession
- ▯
- Intermediate professions
- ▯
- Employee
- ▯
- Unskilled laborer
- ▯
- Retired
- ▯
- No professional activity
- ▯
- Student
- ▯
- Yes
- ▯
- No, where did you consult? _______ ________________________________
- ▯
- Proximity to home or work
- ▯
- Schedule compatibility with my activity
- ▯
- Attending GP unavailable
- ▯
- The appointment proposed by my doctor was not convenient for me
- ▯
- I have moved and I have not yet found a doctor
- ▯
- I don’t have a GP
- ▯
- I am on business travel, so I do not have access to my GP
- ▯
- After advice from my GP or another health professional (another doctor, physiotherapist, nurse, etc.)
- ▯
- I wanted another medical opinion, in addition to that of my GP
- ▯
- I would like to have direct advice from a specialist
- ▯
- I thought I would need additional tests (blood test, imagery, etc.)
- ▯
- I thought I would have to be hospitalized
- ▯
- I’m being followed in the hospital
- ▯
- I chose to consult at the emergency department because it is well known that it is the quickest
- ▯
- I cannot pay any upfront fees
- ▯
- Other:
Appendix C. French Clinical Emergency Department Classification, Classification Clinique des Malades aux Urgences (CCMU)
Classification | Description |
CCMU 1 | Stable situation, abstention from complementary diagnostic or therapeutic act |
CCMU 2 | Stable situation, perform a complementary diagnostic or therapeutic act |
CCMU 3 | Situation likely to deteriorate without being life-threatening |
CCMU 4 | Prognosis committed, no immediate resuscitation maneuver |
CCMU 5 | Prognosis committed, perform immediate resuscitation maneuver |
CCMU P | Patient with psychological or psychiatric problems dominant in the absence of any unstable somatic pathology |
CCMU D | Patient dies at the entrance to the emergency |
Appendix D. Informed Consent
- -
- Sociodemographic categories
- -
- Medical administrative information
- -
- Motivation to consult in the emergency department
- -
- Patient satisfaction
- -
- Dr Aiham Daniel GHAZALI, main investigator, Emergency Department of Bichat Hospital
- -
- Dr Arnaud CHAUDET, Emergency Department of Poitiers Hospital
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Characteristics of Patients | Total n = 598 | Bichat n = 243 | Poitiers n = 355 | p |
---|---|---|---|---|
Male patients, no. (%) | 475 (79.4) | 179 (73.7) | 296 (83.4) | 0.003 |
Age (year), median (IQR *) | 38 (27–50) | 37 (27–50) | 38 (26–49) | 0.74 |
Nearby place of residence **, no. (%) | 314 (52.5) | 140 (57.6) | 174 (49.0) | 0.04 |
Basic Social Security coverage, no. (%) | 511 (85.5) | 200 (82.3) | 311 (87.6) | 0.07 |
Complementary health coverage, no. (%) | 395 (66.1) | 142 (58.4) | 253 (81.4) | 0.04 |
Designated primary care provider, no. (%) | 521 (87.1) | 189 (77.8) | 332 (93.5) | <0.0001 |
Nearby primary care provider, no. (%) | 423 (70.7) | 215 (88.5) | 208 (58.6) | <0.0001 |
Professional category/occupation, no. (%) | 0.27 | |||
Farmers | 5 (0.8) | 1 (0.4) | 4 (1.1) | |
Managers | 50 (8.4) | 29 (11.9) | 21 (5.9) | |
Craftsman/woman | 33 (5.5) | 10 (4.1) | 23 (6.5) | |
Laborers | 48 (8.0) | 21 (8.6) | 27 (7.6) | |
Middle management | 41 (6.9) | 7 (2.9) | 34 (9.6) | |
Employees | 66 (11.0) | 22 (9.1) | 44 (12.4) | |
Inactive | 89 (14.9) | 39 (16.1) | 50 (14.1) | |
Students | 203 (33.9) | 86 (35.4) | 117 (32.9) | |
Retired | 63 (10.6) | 28 (11.5) | 35 (9.9) |
Total of CIMU 5 * Patients | University Hospital of Bichat | University Hospital of Poitiers | |||||||
---|---|---|---|---|---|---|---|---|---|
PCP ** | No PCP | p | PCP | No PCP | p | PCP | No PCP | p | |
08:00–20:00 | 433 | 66 | 0.57 | 161 | 48 | 0.48 | 272 | 18 | 0.66 |
20:00–08:00 | 88 | 11 | 28 | 6 | 60 | 5 | |||
Weekdays | 363 | 56 | 0.58 | 145 | 40 | 0.69 | 218 | 16 | 0.15 |
Weekends/Holidays | 158 | 21 | 44 | 14 | 114 | 7 |
Consultation Reasons | Total n = 598 | Bichat n = 243 | Poitiers n = 355 | p |
---|---|---|---|---|
Cardio-vascular, no. (%) | 26 (4.3) | 13 (5.3) | 13 (3.7) | 0.32 |
Dermatological, no. (%) | 74 (12.4) | 23 (9.5) | 51 (14.4) | 0.07 |
Gastroenterological, no. (%) | 43 (7.2) | 30 (12.4) | 13 (3.7) | <0.0001 |
General and other, no. (%) | 58 (9.7) | 30 (12.4) | 28 (7.9) | 0.07 |
Urogenital, no. (%) | 24 (4.0) | 13 (5.3) | 11 (3.1) | 0.17 |
Neurological, no. (%) | 28 (4.7) | 10 (4.1) | 18 (5.1) | 0.59 |
Ophthalmological, no. (%) | 57 (9.5) | 4 (1.6) | 53 (14.9) | <0.0001 |
ENT, no. (%) | 67 (11.2) | 18 (7.4) | 49 (13.8) | 0.02 |
Psychiatry, no. (%) | 7 (1.2) | 4 (1.6) | 3 (0.8) | 0.45 |
Respiratory, no. (%) | 9 (1.5) | 5 (2.1) | 4 (1.1) | 1 |
Rheumatology, no. (%) | 109 (18.2) | 49 (20.2) | 60 (16.9) | 0.31 |
Traumatology, no. (%) | 96 (16.1) | 44 (18.1) | 52 (14.6) | 0.26 |
Motivation | Total n = 598 | Bichat n = 243 | Poitiers n = 355 | p |
---|---|---|---|---|
Workplace accident, no. (%) | 17 (2.8) | 6 (2.5) | 11 (3.1) | 0.65 |
Suggested by peers, no. (%) | 3 (0.5) | 1 (0.4) | 2 (0.6) | 1.0 |
Suggested by a professional *, no. (%) | 58 (9.7) | 17 (7.0) | 41 (11.6) | 0.06 |
Second opinion, no. (%) | 21 (3.6) | 7 (2.9) | 14 (3.9) | 0.49 |
Intense pain, no. (%) | 27 (4.5) | 9 (3.7) | 18 (5.1) | 0.43 |
Additional testing, no. (%) | 157 (26.3) | 59 (24.3) | 98 (27.6) | 0.36 |
Appointmenthours, no. (%) | 8 (1.3) | 4 (1.6) | 4 (1.1) | 0.59 |
After business hours **, no. (%) | 31 (5.2) | 8 (3.3) | 23 (6.5) | 0.11 |
Hospitalization, no. (%) | 14 (2.3) | 6 (2.5) | 8 (2.3) | 0.86 |
Unavailable PCP ***, no. (%) | 115 (19.2) | 42 (17.3) | 73 (20.6) | 0.32 |
Lack of upfront payment, no. (%) | 22 (3.7) | 13 (5.3) | 9 (2.5) | 0.07 |
Geographic proximity ****, no. (%) | 106 (17.7) | 63 (26.0) | 43 (12.1) | <0.0001 |
Already taken care of in this hospital, no. (%) | 19 (3.2) | 8 (3.2) | 11 (3.0) | 0.89 |
Clinical Severity | Total n = 593 | Bichat n = 242 | Poitiers n = 351 | p |
---|---|---|---|---|
CCMU 1, no. (%) | 399 (67.3) | 167 (69.1) | 232 (66.1) | 0.81 |
CCMU 2, no. (%) | 178 (30.0) | 68 (28.1) | 110 (31.3) | |
CCMU 3, no. (%) | 10 (1.7) | 4 (1.7) | 6 (1.7) | |
CCMU 4, no. (%) | 3 (0.5) | 1 (0.4) | 2 (0.6) | |
CCMU 5, no. (%) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
CCMU P, no. (%) | 3 (0.5) | 2 (0.8) | 1 (0.3) |
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Share and Cite
Ghazali, D.A.; Richard, A.; Chaudet, A.; Choquet, C.; Guericolas, M.; Casalino, E. Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care. Int. J. Environ. Res. Public Health 2019, 16, 4431. https://doi.org/10.3390/ijerph16224431
Ghazali DA, Richard A, Chaudet A, Choquet C, Guericolas M, Casalino E. Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care. International Journal of Environmental Research and Public Health. 2019; 16(22):4431. https://doi.org/10.3390/ijerph16224431
Chicago/Turabian StyleGhazali, Daniel Aiham, Arnaud Richard, Arnaud Chaudet, Christophe Choquet, Maximilien Guericolas, and Enrique Casalino. 2019. "Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care" International Journal of Environmental Research and Public Health 16, no. 22: 4431. https://doi.org/10.3390/ijerph16224431