• S Gentile, A-C Durand, P Vignally, R Sambuc, and P Gerbeaux.
• Laboratoire de santé publique, faculté de médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France. stephanie.gentile@ap-hm.fr
• Rev Epidemiol Sante. 2009 Feb 1;57(1):3-9.

BackgroundEmergency department (ED) utilization has increased for several decades. ED-s are becoming more and more busy because of patients with non-urgent problems, and their demand for service has resulted in overcrowding in ED. To resolve this problem, primary care units involving general practitioners have been established. The objective of this study is to assess provision of the shift to other health care facilities for no urgent ED patients, starting from entry to ED at the request of the triage nurse.MethodsA cross-sectional study was conducted during a one-week period in the adult ED of La Conception Hospital in Marseilles, France. Only no urgent patients identified prospectively by the triage nurse were included. Information was gathered regarding the usual source of care, reason for the visit, care itinerary before presenting to the ED, patient's perception of emergency level, their willingness regarding a reorientation to another health care facility, accomplished actions, and type of discharge.ResultsAmong 245 ED patients, 110 were identified as no urgent by the triage nurse, and 85 effectively answered questions for the purpose of this study. In 76.4% of the cases, the patients were self-referred to ED, however one-third had contacted a physician. The most common reasons provided for attending the ED were pain (55.3%), laboratory and radiographic investigations (37.6%), and difficulty in accessing the usual source of care (22.3%). The mean level of emergency perception was 10.6+/-5.6 on a zero-twenty scale. Half of the patients presented for traumatology concerns. One-third had an additional examination, six received treatments, and none were hospitalized. Upon entry to ED, more than two-thirds of patients accepted the principle of reorientation to another health care facility. Two main factors linked with this decision were employment status (odds-ratio [OR]=4.5; 95% confidence interval [CI]=1.6-12.9) and the perceived emergency level (OR=0.88; 95% CI=0.8-0.9). Among patients who refused reorientation, 41 of them were able to pay an additional cost to receive care in the ED.ConclusionAlternative structures such as primary care units near the ED seem to be an appropriate response to meet the growing demand of no urgent patients. The success of providing this reorientation, however, could be determined by the working hours of the structures and the practice of certain technical skills.

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