Emerg Med J 29:487-491 doi:10.1136/emj.2010.107276
  • Original article

Why do patients with minor or moderate conditions that could be managed in other settings attend the emergency department?

  1. Jon Nicholl
  1. ScHARR, University of Sheffield, Medical Care Research Unit, Sheffield, UK
  1. Correspondence to Patricia Coleman, Medical Care Research Unit, University of Sheffield, Sheffield S1 4DA, UK; p.coleman{at}
  1. Contributors This study was undertaken by RP in fulfilment of an intercalated BMedSci degree. JPN and SM were RP's academic supervisors. PC provided practical research support and assisted in collecting and analysing the data. All four authors contributed to writing the paper.

  • Accepted 4 April 2011
  • Published Online First 11 May 2011


Objectives To estimate the potential of alternative providers of care for minor health problems to reduce demands on emergency departments (EDs).

Methods Data were collected in a type 1 urban ED over a 2-month period in two stages: questionnaire to adult attendees presenting to the ED; and a notes review.

Results The usable response rate was 68% (n=261/384). The notes review confirmed that more than two-thirds of the presenting conditions could have been managed in settings other than the ED. The attendees' reasons on the questionnaire indicated a strong belief that the only provider able to deal with their concerns at that time was the ED. For some users, the ED was not the first contact with a healthcare provider for the same health problem. Few believed that they would be seen quicker in the ED or that the ED was more convenient. The most frequent reason for presenting to the ED was ‘being advised to attend by someone else’. The ‘adviser’ was more likely to be a health professional (doctor or nurse or NHS Direct) than to be ‘friends or family’.

Conclusions Although there appears to be considerable potential for minor conditions to be managed in settings other than the ED, our findings indicate that patients will continue to present these conditions to the ED. Patient perceptions of the urgency of their treatment need, and also the availability and capacity of alternative services may be offsetting their potential to substitute for the ED. Advice from other services may be contributing to demands on the ED.


  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Doncaster NHS ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Relevant Article

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article