Determinants of Emergency Department Use by Ambulatory Patients at an Urban Public Hospital

Study objective: To determine emergency department patients' perceptions of their illness urgency, their attempts to get care elsewhere, and the proportion of patients referred to the ED. Design: Cross-sectional design with self-administered questionnaires or interviews. Setting: Public hospital in Los Angeles County, California. Participants: Consecutive ambulatory patients totaling 1,190. Results: Most patients thought that they required immediate medical attention, even if they said that their condition was not serious, painful, or debilitating. Half of all patients sought care elsewhere before coming to the ED, and 38.2% had seen a doctor. Forty-four percent of all patients said they were referred to the ED by a doctor or a nurse. Referred patients had illness acuteness similar to that of patients who came to the ED on their own. Conclusion: In addition to their lack of access to other providers, patients' perceived need for immediate care and referrals by health professionals contribute to ED use for non-emergency conditions. [Baker DW, Stevens CD, Brook RH: Determinants of emergency department use by ambulatory patients at an urban public hospital. Ann Emerg Med March 1995;25:311-316.]