Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Dr. Richard G Booth


BACKGROUND: Patients present at the emergency department (ED) with a wide range of complaints that range significantly in acuity and complexity. To date, there has been a lack of research exploring factors influential in patients’ decision-making processes with respect to attending the ED for non-urgent matters.

AIM: The purpose of this study was to study non-urgent ED use from both the patient and health care provider perspectives.

METHOD: This study used multiple methods. First, an integrative review was conducted which explored adult patient-reported reasons for using the ED non-urgently. Second, using qualitative methods, health care professionals (HCPs) were recruited from two EDs in Southwestern Ontario to explore perceptions on (a) the role of the ED within the larger healthcare system; (b) how non-urgent visits in the ED are contextualized; and (c) reasons for non-urgent use of the ED by patients. Third, a cluster analysis was performed which identified and characterized unique subgroups of ED patients based on their levels of stress and coping ability; groups were compared with respect to sociodemographic variables, clinical health information, and health literacy.

RESULTS: Seven themes emerged from the integrative review: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. In the qualitative study, HCPs reported that the role of the ED was a multifaceted place to receive quality care and act as a safety net. However, HCPs differentiated non-urgent ED patients by their underlying medical versus psychosocial dispositions. Finally, among 171 ED patients, there were no significant differences in stress, coping, or health literacy levels with respect to triage acuity. The cluster analysis showed three distinct groups of patients with those in Cluster 1 having the greatest levels of stress and avoidant/dysfunctional coping, combined with the lowest health literacy.

CONCLUSION: Future studies should explore further biopsychosocial characteristics driving decision-making as well as their relationship to patients’ high estimation of medical severity.

Summary for Lay Audience

Overloaded emergency departments are a serious and chronic problem in most health care settings. Patients visit the emergency department hoping for treatment for their medical complaint, regardless of severity. While we know some reasons that lead to the non-urgent use of emergency departments, we still do not fully understand how behavioural and social determinants of health could help to explain patients’ decision-making. This study examined the non-urgent use of the emergency department from the perspective of the patient and health care professional. First, we reviewed all the scientific literature on the topic. Second, we asked emergency department nurses and physicians about their perspective on the role of the ED within the healthcare system, how they would describe non-urgent visits, and why they believed patients use the emergency department non-urgently. Finally, we provided emergency department patients with an electronic survey which asked about their levels of stress, methods by which they cope, and their understanding of health knowledge and access. The findings from the study show that patients have very clear problems which need to be addressed. Further, patients are very different from one another, and many factors influence their decision-making. Reducing non-urgent emergency department visits will require solutions which consider the differences and complexity in which patients live. Future studies should continue to explore other personal characteristics which drive decision-making as well as patients’ assessment of their medical severity.

Available for download on Thursday, November 28, 2024