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Low-acuity presentations to the emergency department in Canada: exploring the alternative attempts to avoid presentation
  1. Lynette D Krebs1,
  2. Scott W Kirkland1,
  3. Rajiv Chetram1,
  4. Taylor Nikel1,
  5. Britt Voaklander1,
  6. Alan Davidson1,
  7. Bryn Holroyd1,
  8. Cristina Villa-Roel1,3,
  9. Katelynn Crick2,3,
  10. Stephanie Couperthwaite1,
  11. Chris Alexiu1,
  12. Garnet Cummings1,
  13. Brian H Rowe1,3
  1. 1Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2Departments of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  3. 3School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Brian H Rowe, Department of Emergency Medicine, University of Alberta Hospital, 1G1.43 Walter C. Mackenzie Centre, 8440-112th Street NW, Edmonton, Alberta, Canada T6G 2B7; brian.rowe{at}


Objective ED visits have been rising year on year worldwide. It has been suggested that some of these visits could be avoided if low-acuity patients had better primary care access. This study explored patients' efforts to avoid ED presentation and alternative care sought prior to presentation.

Methods Consecutive adult patients presenting to three urban EDs in Edmonton, Canada, completed a questionnaire collecting demographics, actions attempted to avoid presentation and reasons for presentation. Survey data were cross-referenced to a minimal patient dataset containing ED and demographic information.

Results A total of 1402 patients (66.5%) completed the survey. Although 89.3% of the patients felt that the ED was their best care option, the majority of patients (60.1%) sought alternative care or advice prior to presentation. Men, individuals who presented with injury only, and individuals with less than a high school education were all less likely to seek alternative care. Alternative care actions included visiting a physician (54.1%) or an alternative healthcare professional (eg, chiropractor, physiotherapist, etc; 21.2%), calling physician offices (47%) or the regional health information line (13%). Of those who called their physicians, the majority received advice to present to the ED (67.5%).

Conclusions Most low-acuity patients attempt to avoid ED presentation by seeking alternative care. This analysis identifies groups of individuals in the study region who are less likely to seek alternative care first and may benefit from targeted interventions/education. Other regions may wish to complete a similar profile to determine which patients are less likely to seek alternative care first.

  • emergency department
  • access to care
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  • Presentations: Presented in part at the Western Emergency Department Operations Conference in Alberta, Canada, 2014; Canadian Emergency Physician Association Conference in Ontario, Canada, 2014 and the International Conference on Emergency Medicine, in Hong Kong, 2014.

  • Contributors The project was conceived by BHR, RC and GC. All named co-authors participated sufficiently in the project to claim authorship based on international standards for authorship. SWK coordinated the study; RC, AD, TN, BV, BH and SWK collected the data. Data management was provided by SC, CV-R and KC. Analysis was completed by KC, LDK and CA. All authors contributed to editing the manuscript and are able to take responsibility for the finished product.

  • Funding AIHS (PRIHS-2), Emergency Strategic Clinical Network—AHS, Brain Care Centre. This research was supported by the Emergency Medicine Research Group in the Department of Emergency Medicine at the University of Alberta, Alberta Health Services (AHS) through the Emergency Strategic Clinical Network (AHS), Alberta Innovates Health Solutions (AIHS) through the Partnership for Research and Innovation in the Health System (AIHS PRIHS #201400398) grant and the Brain Care Centre (all in Edmonton, Alberta, Canada). RC was supported by a Summer Studentship from the Alberta Centre for Injury Control and Research in the School of Public Health, University of Alberta, Edmonton, Alberta, Canada. BH was supported by an AIHS Summer Studentship. During this study, CV-R was supported by Canadian Institutes of Health Research (CIHR) in partnership with the Knowledge Translation branch. BHR is supported by the CIHR as a Tier I Canada Research Chair in Evidence-based Emergency Medicine through the Government of Canada. The funders do not take responsibility for the conduct, content and conclusions drawn by the study authors. Funding was secured by DV and BHR.

  • Competing interests None declared.

  • Ethics approval Health Research Ethics Board at the University of Alberta.

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

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