Paradoxical visits to the emergency department: are we meeting patients' needs?

The subject of increasing emergency department (ED) visits is well recognised by western healthcare systems. In particular, whether it was necessary or appropriate for many of these patients to visit ED remains a vexed question. As such, understanding sub populations that visit the emergency department may offer insight and data into how best to deliver the right services in the right settings, while informing operational planning for ambulance services.

The sub-populations that form the focus of this retrospective population-based cohort study are those patients brought to the ED by ambulance, are triaged, but subsequently leave before consulting an ED health provider. This phenomenon has been termed within this paper as a paradoxical visit (PV).

The study setting was the Winnipeg Health Region (WHR), Manitoba, Canada (population 720,000). Between the 1st of April 2012 and the 31st March 2013, the researchers examined anonymised ED records of those visitors ≥17 years old, to capture single and multiple PVs. These were then assessed to establish the prevalence of PVs, the demographics and health status of this sub population of ED visitors.