Emergency Department Visits for Nonurgent Conditions

Systematic Literature Review

Published In: The American Journal of Managed Care, v. 19, no. 1, Jan. 2013, p. 47-59

Posted on RAND.org on January 01, 2013

by Lori Uscher-Pines, Jesse Pines, Arthur L. Kellermann, Emily M. Gillen, Ateev Mehrotra

Read More

Access further information on this document at www.ajmc.com

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Questions

  1. What influences an individual's decision to use an ED for nonurgent conditions?
  2. What are the strengths and weaknesses of the literature on nonurgent visits to the ED?

BACKGROUND: A large proportion of all emergency department (ED) visits in the United States are for nonurgent conditions. Use of the ED for nonurgent conditions may lead to excessive healthcare spending, unnecessary testing and treatment, and weaker patient–primary care provider relationships. OBJECTIVES: To understand the factors influencing an individual's decision to visit an ED for a nonurgent condition. METHODS: We conducted a systematic literature review of the US literature. Multiple databases were searched for US studies published after 1990 that assessed factors associated with nonurgent ED use. Based on those results we developed a conceptual framework. RESULTS: A total of 26 articles met inclusion criteria. No 2 articles used the same exact definition of nonurgent visits. Across the relevant articles, the average fraction of all ED visits that were judged to be nonurgent (whether prospectively at triage or retrospectively following ED evaluation) was 37% (range 8%-62%). Articles were heterogeneous with respect to study design, population, comparison group, and nonurgent definition. The limited evidence suggests that younger age, convenience of the ED compared with alternatives, referral to the ED by a physician, and negative perceptions about alternatives such as primary care providers all play a role in driving nonurgent ED use. CONCLUSIONS: Our structured overview of the literature and conceptual framework can help to inform future research and the development of evidence-based interventions to reduce nonurgent ED use.

Key Findings

A systematic review of existing literature suggests that about 37 percent of ED visits were for nonurgent conditions.

Patients who used the ED for non-urgent conditions:

  • tended to be younger
  • found the ED more convenient than alternatives
  • were referred to the ED by a physicians
  • or had negative perceptions about providers who might be alternatives to ED care.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.