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O’Cathain A, Knowles E, Long J, et al. Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study. Southampton (UK): NIHR Journals Library; 2020 Mar. (Health Services and Delivery Research, No. 8.15.)
Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study.
Show detailsTABLE 15
Authors and year of publication | Relevance code | Definition of sample/participants as described in the paper, and where description(s) can be found (title/abstract/methods) | Service | Comments | Adequacy of description of key aspects of context | ||
---|---|---|---|---|---|---|---|
Service | Geographical setting | Demographic details | |||||
Agarwal et al., 201272 | 1 |
Title: ‘Potentially avoidable ED attendance’ Abstract: ‘could have been managed in an alternative service’ Methods: ‘Suitable to be cared for in an alternative urgent care provider service including primary care’/’attending the ED with urgent care needs that could be managed in other urgent care environments locally’ | ED, two-thirds arriving by ambulance | ‘Non-urgent’ defined to include referral of relatively serious problems (e.g. chest pain, collapse) to a centre staffed by doctors, nurses and emergency practitioners | Yes | No | Yes |
Ahl et al. 200665 | 1 |
Methods: ‘had used ambulance care within the past 3 months . . . selected in order to achieve a large variation in . . . emergency priorities and medical diagnosis’ Background of 2012 paper: ‘pre-hospital care situations that are not defined as traumatic or life threatening’ | Ambulance | – | Yes | Poor | Poor |
Becker et al. 199344 | 2 | Methods: ‘adults with physician-diagnosed and documented asthma’, studying ‘individuals’ response to asthma’ | Mixed emergency/urgent care: service unclear, mostly ED | – | Poor | No | Yes |
Berry et al. 200866 | 1 |
Title: ‘bring children to the ED for nonurgent conditions’ Abstract: ‘choosing the ED over their PCP for nonurgent paediatric care’ Methods: child ‘assigned a nurse triage level of 5 on a 1 to 5 scale (with 5 indicating “no resources likely to be utilized” or a non-urgent problem)’/brought child to ED ‘during hours when physicians’ offices are routinely open’ | PED | – | Yes | Yes | Yes |
Booker et al. 201473 | 1 |
Title: ‘call emergency ambulances for primary care problems’ Abstract: ‘called an ambulance for a primary care-appropriate health problem’ Methods: ‘likely to have been managed successfully in primary care’ | Ambulance | – | Yes | No | Yes |
Brousseau et al. 201145 | 1 |
Abstract: ‘presenting for non-urgent care at a children's hospital ED’ Methods: ‘triaged as nonurgent by the ED triage nurse’ | PED | Some data relate to HCPs’ perceptions | Yes | No | Yes |
Calnan 198346 | 1 | Methods: ‘minor condition . . . according to both the level of medical skill needed to treat the complaint and the facilities available to treat the condition’ – minor cuts ‘requiring cleaning and dressing only which could be carried out by a [nurse] alone’ – and minor illnesses ‘complaints of a non-traumatic nature which could have been treated by a GP’ | ED | – | Yes | No | No |
Capp et al. 201667 | 2 | Abstract: ‘Frequent ED users’ (4–18 visits in past year, if most visits not for mental health or substance abuse reasons) | ED | Sample participating in RCT ‘to improve[e] primary care utilization’ | Yes | Yes | Yes |
Chin et al. 200647 | 1 |
Title: ‘Nonurgent use of a PED’ Abstract: ‘presenting to a PED for nonacute care’ Methods: ‘in the PED whose visits were of low acuity as defined as score of 5 on 5 point Emergency Severity Index’ | PED | Some data relate to HCPs’ perceptions | Poor | Poor | Yes |
de Bont et al. 201548 | 2 | Methods: ‘presenting to the GP OOH centre with a febrile child under the age of 12’ | OOH – delivered by co-op | – | Yes | Yes | Yes |
Durand et al. 20127 | 1 |
Title: ‘Nonurgent patients in ED’ Methods: ‘triaged as nonurgent upon their arrival to the ED by the triage nurse’, nonurgent defined as ‘problem could be taken care of by primary care physician’ | ED | Some data relate to HCPs’ perceptions | Yes | No | Yes |
Fieldston et al. 201249 | 2 |
Title: ‘Nonurgent visits to the ED’ Methods: exploring and describing ‘reasons for nonurgent pediatric ED visits independent of a particular ED visit’ | PED | Some data relate to HCPs’ perceptions | Poor | Yes | Yes |
Goeman et al. 200494 | 2 |
Title: ‘ED reattendance for asthma’ Methods: people with asthma not controlled by their current therapy who ‘reattended emergency departments within 12 months’ | ED | Part of a larger sample where others did not reattend | Yes | Poor | Yes |
Goepp et al. 200485 | 2 |
Results: families from ‘among residents of the East Baltimore neighbour-hoods’ (area with high poverty levels) Conclusions: ‘low-income patients, especially those belonging to minority groups’ | Health service use, particularly PED | Some data ethnographic observations and community support workers’ perceptions and experiences | Yes | Poor | Poor |
Guttman et al. 200350 | 1 |
Title: ‘Medically nonurgent ED visits’ Methods: visit ‘considered medically nonurgent’ by ED triage staff’ | Adult and PED | – | Yes | Poor | Yes |
Mostajer Haqiqi et al. 201681 | 1 | Abstract: parents of child under 10 ‘seeking care for nontraumatic dental problems in the ED’ of a paediatric hospital | PED | – | Yes | Yes | Yes |
Hopton et al. 199651 | 2 | Abstract: adults (or calling on behalf of another adult) or parents ‘who called their doctors out of hours’ | OOH – delivered by general practice | – | Yes | Yes | Poor |
Houston and Pickering 200052 | 2 |
Methods: parents of child under 10; three categories sampled: ‘Frequent users . . . used the service twice or more in the previous 6 months or four times or more in the previous year . . . One-off callers . . . one or more call in the past 6 months and none in the prior 3 years’ ‘Non-callers . . . not used the service in the previous 3 years’ | OOH – delivered by general practice | – | Yes | Yes | Yes |
Howard et al. 200591 | 1 |
Title: ‘choosing the ED for non-urgent medical care’ Methods: ‘seeking treatment in the emergency department for care of a nonurgent complaint and who could articulate the reasons for choosing this source of care as opposed to their PCP’ | ED | – | Yes | Yes | Yes |
Hugenholtz et al. 200953 | 2 |
Title: ‘seeking immediate primary care for their children’ Abstract: ‘ask for immediate medical attention for their children’ Methods: ‘had visited the cooperative with a sick child’. Most coded as U3 by triaging assistant ‘urgent, assess within several hours for medical or emotional reasons’ but, after examination, half needed no treatment or only advice about self-treatment | OOH – delivered by co-op | Second group purposively sampled – ‘children had required immediate referral to hospital care’ – to compare decision-making in two groups | Yes | Poor | Poor |
Hunter et al. 201368 | 2 | Methods: ‘patients with one or more of four LTCs’ – chronic obstructive pulmonary disease, coronary heart disease, asthma and diabetes | Mixed emergency care: ED, WIC and OOH | – | Poor | Poor | Yes |
Keizer Beache and Guell 201682 | 1 |
Title: ‘Nonurgent accident and emergency department use’ Methods: ‘patients who had been triaged as non-urgent by the AED nurse’ | ED | – | Yes | Yes | Yes |
Koziol-McLain et al. 200077 | 1 |
Title: ‘Seeking care for nonurgent medical conditions in the ED’ Methods: ‘discharged from the ED; and . . . triaged as nonurgent upon their arrival in the ED . . . based on a triage category of greater than 2 (triage categories range from 1 (life threatening) to 4)’ | ED | – | Yes | Poor | Poor |
Lawson et al. 201492 | 2 | Methods: ‘patients with documented histories of asthma who were presenting with . . . asthma, shortness of breath, cough, or chest pain’ | ED | – | Yes | Poor | Yes |
MacKichan et al. 201798 | 1 | Methods: ‘Patients who had self-referred to the ED, who attended the ED during GP practice opening hours, who had no investigations while at the ED and/or were discharged with “advice/guidance only”’ | ED | Some data ethnographic observations and staff experiences | Yes | Yes | Yes |
McGuigan and Watson 201054 | 1 |
Title: ‘Nonurgent attendance at EDs’ Methods: ‘non-urgent attenders who had been recorded as “self-referral” by receptionists at . . . ED . . . for whom the ED was the first choice for care’ | ED | – | Poor | No | No |
Neill et al. 201683 | 2 |
Abstract: ‘parents of children under five years, from a range of socioeconomic groups’ Methods: ‘parents in communities with differing social, economic and ethnic profiles’ | Health service use | – | Yes | Yes | Yes |
Olsson and Hansagi 200169 | 2 |
Title: ‘Repeated use of the ED’ Methods: ‘frequent visitor’ defined as ‘a patient who has made four or more visits during the previous 12 months’, focusing on ‘patients who did not require particularly specialised medical care, which is why we used the patient database . . . for general surgery and internal medicine’ (i.e. not gynaecology, ENT, paediatric, psychiatry, etc.) | ED | – | Yes | Poor | Yes |
Shaw et al. 201355 | 1 |
Title: ‘patients who use the ED for primary care needs’ Abstract: ‘patients who were discharged from the low acuity area of a university hospital ED’ Methods: ‘patients who sought treatment in the ED and were triaged to the non-urgent area’ based on the Emergency Severity Index – levels 4 and 5 | ED | – | Yes | Poor | Yes |
Stafford et al. 201456 | 1 |
Abstract: ‘inappropriate attendances at urgent care facilities’ Methods: ‘patients presenting to urgent care . . . diagnosed with simple mechanical back pain by their urgent care clinician’ and meeting the inclusion criterion of ‘requiring only advice and analgesia’ | Mixed emergency/urgent care: ED, WIC and OOH service | – | Poor | No | No |
Wilkin et al. 201284 | 2 | Methods: members of a local community with ‘the second highest rates of calls to 911’ according to hospital data. Some of the participants ‘were identified as 911 users in a previous research project’ | ED | – | No | Yes | Yes |
Woolfenden et al. 200057 | 1 |
Title: ‘use of a paediatric ED as an ambulatory care service’ Methods: ‘parents of children who presented with non-urgent illnesses to a tertiary PED’ | PED | – | Yes | No | Poor |
HCP, health-care professional; OOH, out-of-hours primary care provision; PC, primary care; PED, paediatric emergency department.
Notes
Shaded boxes indicate aspects of context that are not adequately described. Where two or more aspects are shaded, the author/title column is also shaded to indicate that the paper has significant weaknesses in its description of context factors.
Relevance coding. 1: directly relevant, all papers included – aim relates to non-clinically necessary use; sample identified as non-clinically necessary users of urgent/emergency service. 2: partially relevant, all papers included – aim relates to non-clinically necessary use; sample identified as a group who tend to use urgent/emergency services when not clinically necessary (frequent users, people with long-term conditions, parents of young children, people with low social status), but not specifically non-urgent use in this instance.
- Relevance and context appraisal of included qualitative articles - Drivers of ‘c...Relevance and context appraisal of included qualitative articles - Drivers of ‘clinically unnecessary’ use of emergency and urgent care: the DEUCE mixed-methods study
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