Objectives & Background Crowding and exit block have been identified as major issues in emergency medicine, affecting patient safety, effectiveness of care and staff well being. Avoidable attendances (AAs – typically defined as non-urgent, self-referred patients who could be managed effectively and efficiently by other services) have been identified as a factor in the overall problem of crowding. The lack of a universal definition of an AA means these have been estimated to constitute between 10% and 90% of ED attendances.
This study used data from the Royal College of Emergency Medicine's (RCEM) Sentinel Site Survey (SSS) to estimate the proportion of AAs in 12 Emergency Departments (EDs) across the country on a standard day.
Methods 12 EDs across England completed the SSS on 20.03.14, reflecting a standard day in the ED. All patients attending were recorded on the survey with details of investigations/treatments they received. The criteria used to define an appropriate attendance were developed using the questions from the survey, and the proportion of patients thought to be attending avoidably in each department was calculated.
Results Data analysis showed that a mean value of 22.4% (95% CI=20.9%–23.9%) of attendances could be deemed avoidable. Proportions of reported AAs ranged from 11.5% to 49.6%.
With arrival by ambulance, the issue of prescriptions, or both these variables included in the criteria defining an appropriate attendance, this figure fell to 19.4%, 17.6% and 15.1% respectively.
Younger age was shown to be a significant predictor of avoidable attendance, with 40.5% of under 16's attending avoidable, compared to 20.9% of adults aged 16–64 and 6.3% of over 65's.
Conclusion The proportion of potentially avoidable ED attendances shown by this study was lower than the percentages of patients reported to not need treatments in the ED by the Urgent and Emergency Care Review. This suggests that the ED is still the most appropriate healthcare setting for many patients due to the its comprehensive investigations, treatments and capability for urgent referrals. Younger patients were more likely to attend avoidably.
The proportion of AAs is dependent on the defining criteria, highlighting the need for a standardised, universal definition of an appropriate/avoidable ED attendance. This is essential to understanding how AAs contribute to the overall issue of crowding.
- emergency departments
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