Non-Urgent Patients in the Emergency Department at a Hospital in Portugal: Reasons and Characteristics of Use
DOI:
https://doi.org/10.20344/amp.23644Keywords:
Emergency Service, Hospital, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Health Services Misuse, Portugal, Primary Health CareAbstract
Introduction: The increasing demand for emergency services has challenged healthcare systems, largely due to patients whose needs are not urgent, which account for 40.3% of admissions in Portugal.
Methods: A cross-sectional study was conducted over five weeks in the emergency room (ER) of São Sebastião Hospital, Local Health Unit of Entre Douro e Vouga, involving adult patients. Data collection included the review of electronic medical records and the implementation of patient surveys in the ER. The study aimed to identify predictors of non-urgent visits to the ER, using a logistic regression model.
Results: Of the 10 333 patients who visited the ER, 12.3% were classified as non-urgent. The main reasons for seeking the ER included self-perception of symptom severity, undergoing medical tests or immediate treatments, proximity to the hospital, and the perception of higher quality care. Factors such as exemption from co-payment (OR = 0.888), proximity to the hospital (OR = 0.990), having a family doctor (OR = 0.190), knowledge of acute consultations in primary care (OR = 0.428) and telephone line SNS24 (OR = 0.089) were associated with lower odds of unnecessary emergencies. Non-urgent patients were more likely to visit the ER on weekdays (OR = 1.179) and in the morning (OR = 1.637). The probability of a non-urgent episode was 1.8% higher for each additional visit to the ER (OR = 1.018).
Conclusion: Inappropriate use of the ER is influenced by socioeconomic and behavioral factors. The exemption from co-payment was associated with a lower probability of unnecessary emergencies, raising questions about the effectiveness of this co-payment as a moderator of demand. Despite the availability of primary care, the ER was preferred during weekdays and in the morning. The association between awareness of alternatives to the ER and the presence of a family doctor with a lower probability of unnecessary emergencies highlights the need to improve patient health literacy and strengthen primary healthcare services.
Downloads
References
Administração Central do Sistema de Saúde, IP. Indicadores de monitorização dos hospitais. [consultado 2024 ago 25]. Disponível em: https://benchmarking-acss.min-saude.pt/MH_ProdRacioEficUrgenciaDashboard.
Alnasser S, Alharbi M, AAlibrahim A, Aal Ibrahim A, Kentab O, Alassaf W, et al. Analysis of emergency department use by non-urgent patients and their visit characteristics at an academic center. Int J Gen Med. 2023;16:221-32. DOI: https://doi.org/10.2147/IJGM.S391126
Scherer M, Lühmann D, Kazek A, Hansen H, Schäfer I. Patients attending emergency departments. Dtsch Arztebl Int. 2017;114:645-52. DOI: https://doi.org/10.3238/arztebl.2017.0645
Afilalo J, Marinovich A, Afilalo M, Colacone A, Léger R, Unger B, et al. Nonurgent emergency department patient characteristics and barriers to primary care. Acad Emerg Med. 2004;11:1302-10. DOI: https://doi.org/10.1197/j.aem.2004.08.032
Unwin M, Crisp E, Rigby S, Kinsman L. Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol. BMC Health Serv Res. 2018;18:647. DOI: https://doi.org/10.1186/s12913-018-3411-4
Tapia AD, Howard JT, Bebo NL, Pfaff JA, Chin EJ, Trueblood WA, et al. A retrospective review of emergency department visits that may be appropriate for management in non-emergency settings. Mil Med. 2022;187:e1153-9. DOI: https://doi.org/10.1093/milmed/usab553
Carret ML, Fassa AG, Kawachi I. Demand for emergency health service: factors associated with inappropriate use. BMC Health Serv Res. 2007;7:131. DOI: https://doi.org/10.1186/1472-6963-7-131
Vogel JA, Rising KL, Jones J, Bowden ML, Ginde AA, Havranek EP. Reasons patients choose the emergency department over primary care: a qualitative metasynthesis. J Gen Intern Med. 2019;34:2610-9. DOI: https://doi.org/10.1007/s11606-019-05128-x
McIntyre A, Janzen S, Shepherd L, Kerr M, Booth R. An integrative review of adult patient-reported reasons for non-urgent use of the emergency department. BMC Nurs. 2023;22:85. DOI: https://doi.org/10.1186/s12912-023-01251-7
Idil H, Kilic TY, Toker İ, Dura Turan K, Yesilaras M. Non-urgent adult patients in the emergency department: causes and patient characteristics. Turk J Emerg Med. 2018;18:71-4. DOI: https://doi.org/10.1016/j.tjem.2017.10.002
Dixe MA, Passadouro R, Peralta T, Ferreira C, Lourenço G, Sousa PM. Determinantes do acesso ao serviço de urgência por utentes não urgentes. Rev Enf Ref. 2018;4:41-52. DOI: https://doi.org/10.12707/RIV17095
Portugal. Portaria n.º 71/2024. Diário da República, I Série, n.º 41 (27/02/2024). p.1-5.
Grupo Português de Triagem. Manual de formando – triagem de Manchester. [consultado 2024 jan 20]. Disponível em: https://www.grupoportuguestriagem.pt.
Womack JP, Shook J. Gemba walks. 2nd ed. Cambridge: Lean Enterprise Institute; 2011.
Daniel WW, Cross CL. Biostatistics: a foundation for analysis in the health sciences. 11th ed. Hoboken: Wiley; 2018.
Pregibon D. Goodness of link tests for generalized linear models. J R Stat Soc Series C Appl Stat. 1980;29:15-24. DOI: https://doi.org/10.2307/2346405
El-Masri M, Bornais J, Omar A, Crawley J. Predictors of nonurgent emergency visits at a midsize community-based hospital system: secondary analysis of administrative health care data. J Emerg Nurs. 2020;46:478-87. DOI: https://doi.org/10.1016/j.jen.2020.02.002
Portugal. Decreto-Lei n.º 2/2022. Diário da República, I Série, n.º 103 (27/05/2022). p.10-4.
Portugal. Lei n.º 84/2019. Diário da República, I Série, n.º 168 (03/09/2019). p.34-5.
Ramos P, Almeida A. The impact of an increase in user costs on the demand for emergency services: the case of Portuguese hospitals. Health Econ. 2016;25:1372-88. DOI: https://doi.org/10.1002/hec.3223
Oliveira F. Fatores que contribuem para a afluência de casos não urgentes nos serviços de urgência: um estudo no Hospital da Senhora da Oliveira, Guimarães, E.P.E. Universidade do Minho, Escola de Economia e Gestão. [consultado 2025 jul 03]. Disponível em: http://hdl.handle.net/1822/69788.
Gentile S, Vignally P, Durand AC, Gainotti S, Sambuc R, Gerbeaux P. Nonurgent patients in the emergency department? A French formula to prevent misuse. BMC Health Serv Res. 2010;10:66. DOI: https://doi.org/10.1186/1472-6963-10-66
Uscher-Pines L, Pines J, Kellermann A, Gillen E, Mehrotra A. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care. 2013;19:47-59.
Portugal. Decreto-Lei n.º 2/2024. Diário da República, I Série, n.º 4 (05/01/2024). p.41-2.
Pourat N, Davis AC, Chen X, Vrungos S, Kominski GF. In California, primary care continuity was associated with reduced emergency department use and fewer hospitalizations. Health Aff. 2015;34:1113-20. DOI: https://doi.org/10.1377/hlthaff.2014.1165
Simões P, Gomes S, Natário I. Hospital emergency room savings via Health Line S24 in Portugal. Econometrics. 2021;9:8. DOI: https://doi.org/10.3390/econometrics9010008
Carret ML, Fassa AC, Domingues MR. Inappropriate use of emergency services: a systematic review of prevalence and associated factors. Cad Saude Publica. 2009;25:7-28. DOI: https://doi.org/10.1590/S0102-311X2009000100002
Uthman OA, Walker C, Lahiri S, Jenkinson D, Adekanmbi V, Robertson W, et al. General practitioners providing non-urgent care in emergency department: a natural experiment. BMJ Open. 2018;8:e019736. DOI: https://doi.org/10.1136/bmjopen-2017-019736
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
