Do patients use minor injury units appropriately?

BACKGROUND: This study aimed to examine the extent to which patients make appropriate use of Accident and Emergency and Minor Injury Unit services. The outcomes used included the proportion of Minor Injury Unit patients referred to an Accident and Emergency department, comparison between the proportions admitted from patients attending Minor Injury Units and Accident and Emergency departments directly, and the diagnoses and lengths of stay of those requiring admissions from Minor Injury Units.

METHODS: Patients were identified who were resident in the vicinity of Deal and Folkestone and in January 1994 attended local Minor Injury Units in these towns or nearby Accident and Emergency departments at times when the Minor Injury Units were open. The following details were documented from their hospital notes: presenting problem, time and date of attendance, mode of arrival at/referral to the facility, postcode of residence, age, sex, diagnosis and referral/discharge. A sub-sample of 448 patients were interviewed while waiting to be seen at the Minor Injury Units.

RESULTS: The criteria for inclusion in the study were met by 1891 patients. Of these, 188 (9.9 per cent) were referred by a general practitioner (GP). A total of 1472 patients attended the Minor Injury Units without referral from a GP, of whom 28 [1.9 per cent; 95 per cent confidence interval (CI) 1.2-2.6 per cent] were referred for further assessment and care to a general hospital. Whereas 71 (29.5 per cent; 95 per cent CI 23.7-35.3 per cent) of the 241 who went directly to an Accident and Emergency department without GP referral required admission, this was true for only eight (0.5 per cent; 95 per cent CI 0.2-0.9 per cent) self-referred patients attending Minor Injury Units. Four of the latter admissions were for trauma-related problems and required stays of less than 24 hours. Of the patients attending the Deal and Folkestone Minor Injury Units who were interviewed, only 195 (47.0 per cent) said that they would have attended an Accident and Emergency department had the facility not been available; the remainder said that they would have either gone to their own GP or self treated. The latter were more likely to be female patients, to have problems of longer duration, and/or to have attended the facilities by public transport or taxi.

CONCLUSION: The results support the view that patients choose appropriately between attending a Minor Injury Unit or an Accident and Emergency department. However, there was evidence that the availability of an intermediate tier of health care for minor injuries appears likely to result in increased overall workload. This small-scale study leaves unanswered questions in terms of clinical outcomes and the quality of care provided by different facilities.