Why are people increasingly attending the emergency department? A study of the French healthcare system

Emerg Med J. 2019 Sep;36(9):548-553. doi: 10.1136/emermed-2018-208333. Epub 2019 Jul 16.

Abstract

Objective: It is often asserted that the crowding phenomenon in emergency departments (ED) can be explained by an increase in visits considered as non-urgent. The aim of our study was to quantify the increase in ED visit rates and to determine whether this increase was explained by non-severe visit types.

Methods: This observational study covers all ED visits between 2002 and 2015 by adult inhabitants of the Midi-Pyrénées region in France. Their characteristics were collected from the emergency visit summaries. We modelled the visit rates per year using linear regression models, and an increase was considered significant when the 95% CIs did not include zero. The severity of the patients' condition during ED visit was determined through the 'Clinical Classification of Emergency' score. Non-severe visits were those where the patient was stable, and the physician deemed no intervention necessary. Intermediate-severity visits concerned patients who were stable but requiring diagnostic or therapeutic procedures.

Results: The 37 studied EDs managed >7 million visits between 2002 and 2015. There was an average increase of +4.83 (95% CI 4.33 to 5.32) visits per 1000 inhabitants each year. The increase in non-severe visit types was +0.88 (95% CI 0.42 to 1.34) per 1000 inhabitants, while the increase in intermediate-severity visit types was +3.26 (95% CI 2.62 to 3.91) per 1000 inhabitants. This increase affected all age groups and all sexes.

Discussion: It appears that the increase in ED use is not based on an increase in non-severe visit types, with a greater impact of intermediate-severity visit types requiring diagnostic or therapeutic procedures in ED.

Keywords: access to care; emergency care systems, admission avoidance; emergency care systems, primary care; emergency department utilisation; epidemiology.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Crowding / psychology
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • France
  • Health Care Surveys / statistics & numerical data
  • Health Policy / economics
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Patient Admission / statistics & numerical data
  • Registries / statistics & numerical data
  • Severity of Illness Index*
  • Sex Factors
  • Young Adult