Demand for hospital emergency departments: a conceptual understanding

doi:10.5847/wjem.j.1920-8642.2011.04.002

Abstract

Abstract:

BACKGROUND: Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to influence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs.
DATA SOURCES: Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand.
RESULTS: Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship.
CONCLUSION: This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.

Key words: Emergency department, Demand, Crowding, Risk factors, Emergency services, Emergency medicine, Emergency room

Jun He, Xiang-yu Hou, Sam Toloo, Jennifer R Patrick, Gerry Fitz Gerald. Demand for hospital emergency departments: a conceptual understanding[J]. World Journal of Emergency Medicine, 2011, 2(4): 253-261.

Figures/Tables 4

Figure 1.

Table 1

Table 2

Table 3

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Individual needs	Morbidity: chronic disease and acute illness
	Injury
	Other: drug/alcohol dependence
Individual perceptions	Perception of illness: perceived severity, drug abuse precluded regular medical care
	Perception that health status is beyond self control
	Benefits: quality of care, cost effective, convenient
Societal factors	Population growth
	Population ageing
	Seasonal influences: heat waves, disease outbreaks, natural disasters

Age	Older people: more frequent attendance for medical conditions, urgent illness
Age	Younger people: injury, homelessness
Gender	Males more frequent for non-urgent illness
Gender	Female more likely if homeless, HIV infected, for non-urgent illness
Health insurance status	In USA, not privately insured, but Medicare or Medicaid insured
Health insurance status	Uninsured increased rates for ambulatory care or regular care
Socio-economic status	Socio-economic disadvantage associated with homelessness, divorce/separated/widowed, low income
Socio-economic status	In Hong Kong used out of hours by more affluent
Others	Lack of primary care or other more appropriate care
	Poor social support
	Higher levels of education among older people in a rural area

How is health care delivered in society?	Location and number of hospitals
	Availability of alternative health care
	Outpatient capacity
Who is eligible for access to health services via public insurance	Public insurance
	Regulation of private insurance

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