An assessment of inappropriate Emergency Department use in Winnipeg, Manitoba : its extent, causes and proposed solutions

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Crone, Llew
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Winnipeg's Emergency Departments (EDs) contain highly specialized staff and technical resources intended for the rapid diagnosis and treatment of life or limb threatening illness. When prospective assessment of patients' symptoms is used, approximately 30% of patients at Winnipeg's EDs don't require the use of emergency services. When alternative forms of care are readily available, that provide continuity of care and that are medically adequate, such use of EDs is inappropriate. Inappropriate use may be attributed to patients' perception of enhanced convenience, certainty of service and high quality care compared to the alternatives. These perceptions are for the most part inaccurate. In terms of convenience, certainty of service during office hours and overall quality of care, service from General Practitioners compares favourably to emergency service. These misconceptions were created and maintained by incentives inherent in the fee-for-service method of remunerating physicians for their services, by incentives to ED staff which encourage the over-servicing of patients, and by incentive to those holding elected public office. In effect, EDs are used inappropriately because the general population has been encouraged to do so. So long as inappropriate users are not discouraged from using the ED or encouraged to use alternative services, attempts to curtail inappropriate use will likely prove futile. Currently the incentives for both providers and users of ED services are flawed. First, an approach to more appropriate ED use will require that GPs have an incentive to welcome and pursue the patronage of those suffering unexpected illness. Second, ED staff must be given incentive to discourage inappropriate ED use. Third, elected public officials are rewarded for the provision and maintenance of unjustified ED facilities and they must have the incentive to restrict usage.