Injury self-assessment driving ED attendances at University Hospital Limerick, reveals study

A NEW study has found that between 18 and 35% of Emergency Department (ED) attendances may be non-urgent.

The Better Data, Better Planning (BDBP) study, a multi-centre, cross-sectional study of five urban and rural EDs in Ireland, including at UHL, was designed by clinicians to gain a better understanding of the dynamics behind ED presentations.

It was led by Dr Niamh Cummins, associate professor in public health at the University of Limerick’s School of Medicine.

Self-assessment of illness severity can be challenging for patients but is one of the factors driving ED attendance.

This study’s importance has gained even more prominence in light of the record-breaking number of patients on trolleys recorded at UHL earlier this week.

In relation to health-seeking behaviour the BDBP study indicated that nearly half (48%) of the patients presenting to the ED considered their condition to be an emergency and 38% had symptoms for more than 7 days prior to presentation.

Dr Cummins found other reasons for attendance to the ED included a need for reassurance (23%), to see a nurse or doctor quickly (20%), to see a specialist or to obtain a second opinion.

She noted: “It’s clear that a combination of physiological, psychological and social factors impact the decisions of patients to present to the ED and it is the case that many patients attend the ED due to a gap in other services.”

As a result, Dr Cummins emphasised the importance of utilising other care options before presenting at the ED.
“Our previous research also highlighted that less than 60% of patients were aware of out-of-hours GP services so increasing awareness of services such as ShannonDoc is important,” she stressed.

Published research from the BDBP study highlighted the fact that the most common clinical presentation to the ED was musculoskeletal injuries which made up almost a quarter of all attendances (24%).

“These injuries can be treated at Local Injury Units so there is a need to expand these services and there may be potential for initiatives such as mobile X-ray clinics and other diagnostic services in the community,” she stated.

While there is no “magic bullet” to solve the trolley crisis, the researcher added: “Increasing the healthcare workforce, hospital bed capacity and step-down care in the community would help ease the burden.” The study will provide a foundation for policymakers to develop solutions to benefit patients.