Seeking care for nonurgent medical conditions in the emergency department: through the eyes of the patient.

INTRODUCTION: The policy goal of shifting nonurgent visits from the emergency department to nonemergency health care settings is commonly devised, planned, and implemented without considering patients' perspectives. The purpose of this study was to gain an understanding of the context in which patients choose to seek health care in an emergency department. Human science provided the framework for this exploratory descriptive research study.

METHODS: This study was conducted at an urban, university emergency department in Denver, Colo. Uninsured adult patients triaged as nonurgent who were being discharged home were eligible to participate. Eligible patients from 15 randomly selected shifts were asked to participate. Following their ED visit, open-ended interviews began with the question, "Can you tell me the story, or the chain of events, that led to your coming to the emergency department today?" Each interview was audiotaped. Transcripts were analyzed to identify common themes. Patients also rated their severity of illness from 1 (not severe) to 5 (life-threatening), and they rated their satisfaction with the health care they received from 1 (not satisfied) to 5 (extremely satisfied).

RESULTS: The 30 study participants ranged in age from 17 to 60 years; 22 participants (73%) were women. Most patients (73%) rated their severity of illness as 3 or less and their satisfaction with the health care they received as 4 or more (83%). Five themes for seeking care were identified: (1) toughing it out, (2) symptoms overwhelming self-care measures, (3) calling a friend, (4) nowhere else to go, and (5) convenience. Despite the fact that the patients had nonurgent medical problems, their stories revealed that distress in their lives had influenced their need for emergency care.

CONCLUSIONS: Access was prominent in the minds of uninsured patients seeking ED care for nonurgent medical diagnoses. Typically, patients did not perceive themselves as having an urgent problem, had been unsuccessful in gaining access to alternative non-ED health care settings, and found the emergency department to be a convenient and quality source of health care. The patients' stories relayed a context for ED visits that goes beyond medical diagnoses. This perspective has important implications for quality care delivery and for including patients in planning ways to access emergency health care.