Emergency Department use: Why do patients choose the Emergency Department for medical care and how much does it really cost?

Abstract

Background: It is important to understand Canadians' expectations of health care services and the costs of delivering care in the Emergency Department (ED) in order to continue to provide health care in a sustainable manner. Objectives: To examine the reasons patients present to the ED, and to conduct a cost analysis to compare the costs of seeking care in the ED versus a primary care setting. Methodology: We surveyed patients (n=606) triaged to the cubicles of the ED of The Ottawa Hospital, Civic Campus. The survey asked about their perceived urgency level and their patterns of health service use. Patient surveys were accompanied by physician surveys to assess each patient's level of urgency from a medical perspective. We performed bivariate analysis and logistic regression on survey variables of interest. We also conducted a cost analysis to determine the costs of providing non-urgent care in the ED. Results: Both a presenting symptom of a musculoskeletal injury (OR=2.93, CI 1.42-6.04) and having heard of TeleHealth Ontario (OR=2.08, CI1.08-4.03) were significantly associated with non-urgent ED use from the patient perspective. We also found that non-urgent ED visits cost an average of $248.75, which is significantly more costly than a primary care visit. Implications: Our results provide insights regarding patient factors influencing ED use and relative costs of non-urgent ED visits versus outpatient family doctor visits. However, additional work may be required to identify non-medical factors influencing patient motivations for seeking care in the ED.