| Background:Emergency department overcrowding has become a global medical and health problem,in which the increase of non-urgent patients is an important reason.Non-urgent patients refer to the conditions where they should go to the outpatients or community hospitals,while they pour into the emergency departments(EDs).In recent years,the phenomenon of non-urgent emergency visit is very common with the volume of emergency visits in China increasing.There is a large scope of work analyzing rates of nonurgent ED utilization within various populations.However,similar researches of the non-urgent patient visits are still relatively few in our country.To study the epidemiological characteristics of non-urgent patient visits in ED,we compared the ED non-urgent visits(NUV)with urgent visits(UV)in a grade A tertiary hospital,expecting to provide data and evidence for the study of non-urgent patients.We also expected it could offer refence for relieving emergency overcrowding and promoting general medicine to develop in China.Methods:In this study,a cross-sectional study was conducted to observe the data of the patients in a comprehensive hospital from January 1,2017 to December 31,2017.The study information contained sex,age,time for treatment,clinical diagnosis,emergency classification,medical insurance,the cost of medical treatment and so on.The triage is divided IV grade(NUV)and I-III grade(UV)in this study.The triage scale of the ED is based on the"process",which had good reliability and validity.We use the proportion to describe the epidemiological characteristics of NUV,with demographic characteristics,diagnosis,visit time and frequent users in ED.The main factor was proportion of calculation index,comparing the difference between NUV and UV.Besides,Logistic regression analysis was applied to analyze the influence factors of NUV.Results:A total of 167,137 visits in 2017 in this 3A hospital,of which non-urgent patient visits is 113,448,accounting for 67.88%.The results showed that:(1)Compared with UV,there were statistically significant differences in gender,age,medical department,medical insurance type,visiting costs,the seasons and months and hours of visiting,the frequent users in ED(p<0.001).We found that the average age and medical cost were lower than UV.What' s more,it is was higher proportion in NUV with emergency pediatrics,medical insurance in Beijing,and there are greater number visits in winter,especially in December.As for the daily visits,more NUV prefer to ED after 8am or 7pm in the hospital.Besides,the change of NUV visiting patients is higher between weekdays and weekends/long holidays than that of UV.However,the proportion of women,middle and young people,self-paid patients,cost more than 1000 yuan and ED frequent users in NUV is less than in UV.There was no statistical difference between the daylight or night visits.(2)Among the NUV,the ratio of men to women was 1:1.33,and the median age was 42.85 + 22.977 years-old,in which the proportion of women aged between 25 years-old and 34 years-old was the largest.There were most visits occurring in the emergency internal medicine(50.34%)and the most common symptoms was fever(26.63%).To our surprised,abdominal pain was the most symptoms in the emergency internal medicine.The main type of medical insurance is Beijing medical insurance(57.57%),with the largest number of medical insurance for staff and workers in Beijing(65.39%).We also found the average cost of NUV was 542.40 + 2466.309 yuan,with cost below 200 yuan is the highest proportion(50.42%).In terms of visiting time,the largest number of visits was in winter,and December was the peak of visits in the whole year(12412 visits).The peak time of visits was 8:00-11:00,19:00-22:00 and 14:00-16:00,and the number of NUV at daylight was higher than that at night(43.89%).It was various between weekdays and weekends/holidays in the average number of visits.We found it is lower in the weekdays than that of weekends and long holidays.Besides,the average number of NUV during the long holidays is different.The visits number in Spring Festival was lower than that of in National Day.There were 5060 frequent flyers in the non-urgent patients,accounting for 10.32%.(3)Logistic analysis found that visiting department,the cost of medical treatment,the type of medical insurance,the time of medical treatment,the sex and age all affected the non-urgent patients.Conclusion:More than 2/3 of the ED visits in the hospital are non-urgent.Most of visits occurred in emergency internal medicine,with medical insurance in Beijing.Winter is the peak period of NUV treatment,and the number visits has increased after 8am or 7pm,meanwhile they are more likely to go to ED at weekends and long holidays.Epidemiological characteristics differ between NUV and UV.Female,young and middle-aged,ED frequent users may be the characteristics of emergency department visits,while children and elderly patients,lower cost are more likely to be non-urgent patients.Seasonal diseases affect the visits of non-urgent patients,and medical reform policy may have an influence on the choice of NUV,but further studies are needed. |
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