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APHA Scientific Session and Event Listing

Recorded presentation

Robin Rosen, MD, MPH, Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032, 214-648-3280, nyrobinr@yahoo.com and Dan Culica, MD, PhD, American Hospital Association, Health Research and Educational Trust, One North Franklin Street, Suite 30132, Chicago, IL 60606.

Emergency department overcrowding is threatening the stability of the safety net provided by these units. Inappropriate emergency department use by patients with nonemergent complaints is a major contributor to this problem. Understanding patients' priorities in health care seeking behavior and the perceived benefits of using a hospital facility rather than a clinic for nonemergent conditions is an important step in addressing the issue of inappropriate utilization. The purpose of this study was to delineate why women chose to present to an obstetric and gynecologic (OB/GYN) emergency room with nonemergent complaints.

Data were collected with an anonymous written questionnaire distributed to a convenience sample of 500 patients in the Parkland Memorial Hospital OB/GYN emergency room (Intermediate Care Center or ICC). Parkland is the main teaching hospital of the University of Texas Southwestern Medical School and the largest public hospital in North-East Texas, serving primarily a low income and indigent population. The questionnaire was designed to elucidate the reasons why women chose the ICC for their care on the day of participation and to identify the factors subjects deemed most important in choosing where to receive medical care in general. Patients were also asked to assess the urgency of their chief complaint. Descriptive statistics were generated and the importance of different factors evaluated by a goodness of fit test.

Our results indicated that the major reasons participants utilized the Parkland OB/GYN emergency department (ICC) for nonemergent problems other than having no other alternative (14%) were: having a high level of confidence in the quality of the care they would receive (31%), availability of all necessary diagnostic tests (9%), and not having to make a prepayment (8%). Factors identified as the most important in deciding where to receive medical care in general were: how quickly they could get an appointment (21%), the availability of night and weekend care (15%), and whether prepayment was required (15%). Most subjects overrated the urgency of their condition (80% emergent) when compared to the rating given by their health care provider (3% emergent).

Clearly, any attempts to decrease OB/GYN emergency department use for nonemergent problems must address patient priorities and beliefs. Strategies devised by healthcare professionals that do not incorporate the factors which motivate patients are likely doomed to failure. These data cannot be extrapolated from national databases but only from direct patient surveys. These findings are likely to be applicable to other facilities with similar patient populations.

Learning Objectives:

• At the conclusion of the session the participant will be able to
• •Discuss the extent and consequences of emergency department overutilization
• •List the primary reasons why women used the Parkland OB/GYN emergency room for nonemergent problems
• •Describe the most important determinants of healthcare seeking behavior in the target population

Keywords: Emergency Department/Room, Women's Health

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation