Inappropriate use of the emergency department for nonurgent conditions: Patient characteristics and associated factors at a Japanese hospital

Background The purpose of this study was to investigate the primary factors associated with inappropriate out‐of‐hours emergency department (ED) use by patients with nonurgent conditions. Methods We compared patients with nonurgent conditions who made inappropriate, out‐of‐hours ED visits to patients who visited an acute care hospital during daytime consultation hours between May 30 and October 16, 2014, in terms of patient characteristics and reasons for consultation. Our goal was to identify factors associated with inappropriate ED use, defined as an out‐of‐hours, nonurgent, and unnecessary visits. Results We analyzed data from 84 patients who made inappropriate use of out‐of‐hours emergency care and 147 patients who sought care during regular consultation hours. In the inappropriate use group, “desire to be cured quickly” was the most common reason. Acute upper respiratory infection, acute gastroenteritis, and primary headache comprised 51.1% of diagnoses in the inappropriate use group. One factor associated with inappropriate use was two or more previous out‐of‐hours ED visits (odds ratio (OR) 3.19; 95% confidence interval (CI) 1.22‐8.31) (reference: 0 visits). Conclusions Patients with two or more previous out‐of‐hours ED visits were more than three times as likely to inappropriately use the ED compared to patients who had not visited the ED at all in the past 3 years. Inappropriate out‐of‐hours emergency department use by patients with nonurgent conditions has become a problem. To address this problem, understanding the context and associated factors is necessary. In this study, we showed that two or more previous out‐of‐hours emergency department visits were related to inappropriate use of emergency department.