tThe pain, the first ground of appeal for emergency treatment deemed non-urgent

Pain is the primary reason for use of emergency departments for care demands considered non-urgent, according to a study presented at the Emergency Congress in Paris.
All emergency services find their increased activity over the past ten years. Several teams have tried to understand the reasons for this increased use.

A. Durand and colleagues at the Public Health Laboratory of the Faculty of Medicine of Marseille conducted a study in an emergency department to identify cases of non-urgent requests that could actually be supported in private practice.

The study was conducted in an emergency department for adults, for 15 days, 24 hours 24.

On 1526 patients who were switched to emergencies, 276 (17.9%) were considered under care "non-urgent". The majority came during the day (76.3%) and week (64.1%). Day "peak" was the Monday and Saturday. They came by themselves in 67.6% of cases and only 6.1% were referred by their doctor.

The primary reason for emergency department visits for non-urgent request was pain (40% of cases). Pain, "says the patient needs to be treated quickly in an available service. Patient search all means at its disposal to end his pain while professionals give primacy to symptoms," the researchers comment.

Injuries and wounds are the second ground of appeal for emergency care can meet in private practice (19.6% of cases).

According to the authors, "patients do not seek alternative in private practice because of the difficulty to quickly access a technical platform."

Patients were indeed selected emergencies "for their intrinsic characteristics (availability, accessibility, technical equipment), in 35% of cases. Emergencies seem to be victims of their availability and their high-tech."

In another study conducted at the René Dubos (Val-d'Oise) Hospital Pontoise, the "inappropriate" use of emergency was also related to pain in 42% of cases and trauma in 36%.

To explain their arrival, patients noted the lack of availability of the treating physician (33%), the removal of his office (7%), the immediacy of emergency (13%) and confidence in the hospital (11 %).

"The patient presenting to the ED for a simple consultation mostly already know the hospital and the emergency is young, has a social security [..] is looking for a fast and efficient decision support, less personal than which is carried out by the family doctor ", note E. Kla and colleagues.

A study by the Regional Observatory Emergency Midi-Pyrenees also shows that about 10% of cases, patients coming to the emergency room for non-urgent care phoned prior to Samu.

"These findings raise the issue of referral to the steady state of emergency in the regulation by the ambulance service," find Ducassé Jean-Louis and his colleagues at Toulouse.

They also believe that the coming emergency "is often a lack of knowledge of the healthcare system in the city" and suggest to improve the knowledge of the device users.