Characteristics of emergency department utilization in the U.S.A. and the U.K.: a comparison of two teaching hospitals.

Abstract

Appropriate patient use of the accident and emergency (A&E) department has been a subject of concern in the medical literature of both the United Kingdom and the United States for years. Over a century ago the Lancet (1869) published a series of reports on outpatient visits in London hospitals. Citing the 'large numbers of apparently trivial cases' seen in out-patient departments, the authors urged curtailment of services. In more recent years, both Fry (1960) and Crombie (1959) concluded that a majority of patients attending their respective A&E departments in the U.K. had conditions that could have been managed by a general practitioner. In the U.K., both the Platt Report (1962) and the Expenditure Committee on Accident and Emergency Services (1974) recommended that non-urgent cases should first seek care from their general practitioner (G.P.), not the A&E department. In the U.S.A., the literature of the 70's estimated that between half and twothirds of patient visits were 'for routine primary health care'. (Gibson, 1978). In 1980 Gifford et al. reported the results of a survey of emergency department (ED) physicians in 24 hospitals. The assessment indicated that at least 33% of the patients could have safely waited over 12 h for care. A recent report indicated that 25% of patients in one E.D. used the department for routine care. Eighty-three per cent of such patients had public and/or self-pay insurance status (Pane et al., 1991). Despite some apparent similarities of non-urgent use patterns of emergency facilities in the U.K. and the U.S.A., we suspected that close inspection might reveal important differences in each patient population. The countries have quite different systems of medical care reimbursement for physicians and hospitals,