Inter-level and Seasonal Variation in Reasons for Inappropriate Emergency Department Use: A Three Centers Study

Aim: Inappropriate emergency department (ED) use represents an important problem for health systems across the world. This study was designed to determine the reasons for inappropriate ED visits at different ED care levels during different seasons. Materials and Methods: The study was conducted in three hospitals with different ED care levels in two periods (March and July). Physicians determined the appropriateness of ED visits. Data were collected through face-to-face interviews using a researcher-made questionnaire. Results: The inappropriate ED visit rate was 75.6%. The most frequent reasons for inappropriate ED visits according to different ED care levels were as follows: Level 1, easy access (61.2%); Level 2, no other units providing health services outside of working hours (43.0%); and Level 3, perceived need for serum/injection treatment (58.2%). Inappropriate ED visits due to these reasons occurred more frequently in July than in March, with significant differences observed across the various levels of ED (p<0.005). Of the inappropriate users, 36.3% reported that receiving treatment and care from the ED made them feel valued. Conclusion: Easy access was the most common reason for inappropriate ED visits in both study periods. In addition, ED visits make some patients feel valued, which may lead to inappropriate use.