Are clinical emergency departments used appropriately? Results from a combined patient survey and analysis of the medical documents in emergency departments in Berlin

How often are emergency department patients admitted to hospital? Which parameters have an impact on (in)adequate utilization? How large is the number of frequent users of emergency departments (ED)? This was a prospective cross-sectional study in two clinical EDs in the inner city of Berlin (November 2006-February 2007). Sociodemographic and medical data collected in standardized patient interviews (108 questions) were combined with data retrieved from the ED medical documentation (anamnesis, examination results, diagnosis, therapy, administrative data). To evaluate the appropriateness of the utilization a 6-criteria index, including transport to the ED, specific diagnostics, hospitalization, admission to the ED by a physician as well as strong complaints and high urgency for medical treatment from the patient's viewpoint was constructed. A total of 412 patients were included in the study and 29% of the female and approximately 43% of the male patients were hospitalized. Of the patients questioned 13% with 3 or more visits to the ED within the last 12 months were labelled frequent users. In 12% of the patients at least 4 of the 6 criteria used to define appropriate use in this study were met. Only higher age was a significant predictor for appropriate use. Ethnic Turkish (male or female) patients or other immigrant patient groups did not show a significantly different pattern of use of outpatient clinics than ethnic German (male or female) patients. The analysis showed that EDs in the inner city of Berlin do not represent the adequate care unit for much more than 80% of the patients. Considering health care needs and the optimal provision of resources, inappropriate use as well as inadequate service provision to varying degrees can be assumed.