Modifiers of patients' emergency department care-seeking behavior

Background: Inflow of patients to the emergency departments (ED) is increasing in many parts of the world, including Sweden. At the same time the number of EDs are decreasing. In addition to this, ED inflow is volatile. To some degree this volatility is explicable with variations over the hour of the day, day of the week and season, but a considerable portion of the ED inflow is yet to be explained in order to be able to predict the coming load on EDs.

Aim: The overall aim of this thesis is to explore different factors modifying ED inflow.

Methods: In four studies, different possible modifiers of ED inflow and modifiers of the patients’ decision to seek ED care was explored. In Study I, laypersons ability to triage trauma cases was investigated in a prospective survey study. In Study II – IV, retrospective observational studies were conducted. Studies II and III explored the impact of online health information seeking and the effect of news media reporting on ED inflow, respectively. In study II, a forecasting model was constructed, including website visits as explanatory variable, Study IV assessed the impact of callers’ sociodemographic background on advice from a telephone advice service (TAS) and compliance to those advices.

Results: For Study I, 69 persons participated in the study, who in total triaged 52 % of the cases correctly. There was an over-triage (i.e. case triaged as more serious than it was) in 12.5 % and under-triage in 6.3 % of the cases. In Study II, correlation between a population’s number of visits to a regional website for health information and physical ED inflow was found. The forecasting model in Study II exhibited Mean Absolute Percentage Error of 4.8 %. In Study III, it was shown that news media reporting negativity, expressed as a numeric index, significantly correlated to and partially explained ED inflow. In Study IV, findings were that both the advices given to a caller by the TAS and the caller’s odds of complying to the advice were affected by sociodemographic factors, but that the compliance was also affected by the advice issued.

Conclusions: This thesis shows that ED care-seeking behavior is modified by online health information, news media reporting, advices from the TAS and by the individual’s own sociodemographic background. This knowledge can be used to better understand ED care-seeking behavior and to construct better forecasting models of ED inflow.

List of scientific papers

I. NORDBERG M, Castrén M, Lindström V. Primary Trauma Triage Performed by Bystanders: An Observation Study. Prehospital and Disaster Medicine. 2016, 31(4), 353-7.
https://doi.org/10.1017/S1049023X1600039X

II. Ekström A, Kurland L, Farrokhnia N, Castrén M, NORDBERG M. Forecasting emergency department visits using internet data. Annals of Emergency Medicine. 2015, 65(4), 436-442.
https://doi.org/10.1016/j.annemergmed.2014.10.008

III. NORDBERG M, Eriksson O, Ekström A, Castrén M, Lindström V. News Media sentiment and Emergency Department attendance. [Manuscript]

IV. NORDBERG M, Erså Z, Kurland L, Lindström V. Calls to the Swedish Telephone Advice Service - outcome and compliance. [Manuscript]