Appropriateness in utilization of emergency department services in Hospital Kota Bharu and Hospital Universiti Sains Malaysia

• Main Author: Naing@Sadiq, Lin@Mohd Ayub
• Format: Article
• Language: English
• Published: Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia 2003
• Subjects: RA Public aspects of medicine
• Online Access: http://eprints.usm.my/44983/1/GP...Appropiateness%20in%20Utilization%20of%20Emergency%20Department%20Services%20in%20Hospital%20Kota%20Bharu%20and%20Hospital%20Universiti%20Sains%20Malaysia%20%282003%29...-Eprints.pdf; http://eprints.usm.my/44983/
• Institution: Universiti Sains Malaysia

The prime concern in the inappropriate utilization of emergency departments antara J00-200 perkataan di (ED) is compromised management of patients requiring emergency treatment. dalam Bahasa Malaysia dan Significant attendance of non-emergency cases in ED was found in several Bahasa lnggeris. lni countries. kemudiannya akan dimuatkan ke dalam Laporan Talmnan Sahagian Penyelidikan & Pembangunan sebagai safll cara 11ntuk menyampaikan dapatan projek tuanl puan kepada pihak Universiti). The objectives of this study are to determine the proportion of inappropriate cases, as well as the distribution of utilization by time (over 24 hours and within a week) and by diagnoses (Phase I) and to determine the associated factors and the reported reasons in the inappropriate utilization of ED services (Phase II). A cross sectional study (Phase I) was conducted in ED, Hospital Kota Bharu (HKB) and ED, Hospital Universiti Sains Malaysia (HUSM). A sample of 350 cases from each ED was randomly selected from ED register of the year 2000. A decision flowchart, which was adopted from 4 guidelines, was applied to identify inappropriate cases. The proportions of inappropriate cases were 57.4 % for ED HKB and 55 % for ED HUSM. The inappropriate cases increased considerably in early morning, late evening, during the weekend and early part of the week. Most common diagnoses of inappropriate cases were upper respiratory tract infections, mild acute gastroenteritis and urinary tract infections. The subsequent case-control study (Phase II) with 170 cases in each group revealed the independently significant factors associated with inappropriate utilization of ED services such as perceived il lness (Odds Ratio (OR)=9.13; 95% Confidence Interval (CI): 4.99, 16.67), knowledge on roles and functions ofED (OR=0.65; 95% Cl : 0.50, 0.85}, knowledge on roles and functions of OPD (OR=0.24; 95% Cl: 0.13, 0.44), marital status (OR=4.58; 95% Cl : 1.16, 18.06), gender (OR= 3.00; 95% Cl: 1.73, 5.18), number of family members (OR=0.88; 95% Cl: 0.79, 0.97), and shift-work (OR= 2.34; 95% Cl: 1.15, 4.71). The first 3 factors seem to be modifiable by giving education, whereas the later 4 factors give some understanding on customer needs, which may help to customize ED and OPD services. Studies to explore further on customer needs and customizing the hospital services accordingly, which will lead to a more efficient primary care, are recommended.