Decoding patient behaviour : motivations behind moderate and low-acuity visits to the emergency department

Abstract

Background: Emergency Departments are challenged globally by a rising volume of medium and low-acuity patients who strain resources and contribute significantly to overcrowding. Although these non-urgent presentations could be managed elsewhere, the patient-centred motivations and the actual care experienced remain poorly understood. This thesis addresses this critical gap by examining attendance patterns of medium- and low-acuity patients at a large ED in Malta. Aim & Objectives: This study aims to characterise the journey of medium and lowacuity patients attending an Emergency Department by systematically investigating the mode and reasons for their attendance, the healthcare received before their presentation, the clinical interventions and care provided within an Emergency Department and the subsequent discharge destination upon leaving the department. Design & Method: A cross-sectional descriptive design using structured interviews was designed. Due to a poor response, the tool was changed to a self-administered questionnaire given to participants who were triaged as ESI 3, 4, or 5 whilst waiting in the reception area of a major public hospital. Data was collected over 6 months across specific 4-hourly time slots evenly distributed across the 24-hour period of each day. The final sample of 383 participants created a 95% confidence level and 5% margin of error. Data was analysed using descriptive and inferential statistics in SPSS. Results: Most participants were Maltese, with an average age of 52.6 years, and the majority were triaged as ESI 3 and arrived walking. Abdominal pain, headaches, nausea and limb issues were the most frequent complaints, typically of new onset. Two-thirds of patients attempted some form of self-management, most commonly analgesics, but reported limited effectiveness. Many also sought prior care, often from private GPs or health centres, yet attended the ED when symptoms persisted or following referral. Significant associations were found between condition type, symptom duration, and variables such as age, employment, and nationality. ED interventions were dominated by blood tests, treatments, and imaging, with just over one-quarter of cases requiring hospital admission. Conclusion: A “typical” patient profile is presented. By "decoding" this behaviour, this thesis offers insights that directly inform the design of more appropriate alternatives, ensuring they meet the patient's needs and perceptions, not just clinical criteria.