From 1995 to 1998, researchers from the University of Medicine and Dentistry of New Jersey examined why people use hospital emergency departments for medically nonurgent situations-a situation that, according to some studies, occurs in as many as two-thirds of pediatric visits to emergency departments.

Researchers gathered data for the study at two urban New Jersey hospitals and four clinics through:

• Interviews with parents who had brought their children to the emergency department and, to compare perspectives, emergency department physicians and nurses.
• Interviews with adults who used emergency rooms for nonurgent care and, to compare perspectives, adults who used health centers/clinics for urgent care.

Key Findings

• Parents said they chose the emergency department because:
  • They are treated well there.
  • They do not need an appointment.
  • Services are available after working hours.
• Most providers felt that parents used the emergency department because of lack of insurance or lack of access to facilities that accept people with public insurance.
• Most clinic users see the health center as an optimal place for primary care, while some emergency department users consider the emergency department better than or equal to the clinic.

Key Conclusions

• Researchers concluded that educating parents and providers would not change the usage of the emergency department for medically nonurgent visits since:
  • Parents often perceive the emergency department as providing better care than neighborhood clinics.
  • Providers do not agree on a definition of an inappropriate emergency department visit.

Key Recommendations

Researchers drew a number of recommendations from the study about services that primary-care clinics could provide that could lower emergency department use for non-emergencies:

• Emphasize the availability of phone consultation services 24-hours a day and educate patients about how to use them, since many of them may not be comfortable using the phone.
• Consider incorporating services such as medical tests and an on-site pharmacy.
• Develop highly accessible consultation services for medical concerns and educational interventions in order to meet the needs of patients for immediate reassurance.
• Extend office hours even further to meet the needs of patients.

Funding

The Robert Wood Johnson Foundation (RWJF) funded this project through two grants totaling $25,848.