Understanding Non-emergency Patients Admitted to Hospitals Through the Emergency Department for Efficient ED Functions

Published:August 27, 2009DOI:


      ED overcrowding and inefficient flow are closely related to the presence of non-emergency patients. This study aims to examine the characteristics of the non-emergency patients admitted to hospitals through the emergency department by comparison with emergency ED patients and inpatients admitted through outpatient departments, in terms of patient demographics and health care utilization and outcomes.


      This study used an exploratory descriptive design. The retrospective data of 280,104 patients from 38 hospitals were analyzed. χ2 Tests and logistic regression analyses were performed to determine significant differences among the 3 patient groups.


      Among the patients admitted through the emergency department, 13.1% were non-emergency patients. These non-emergency ED patients showed different health care utilization characteristics: 42.8% had 4 or more diagnoses, 90.3% had 5 or more laboratory tests, and 89.4% had radiology tests. After we controlled for patient characteristics and health care utilization variables, mortality risk of emergency ED patients was 2-fold higher than that of non-emergency ED patients and standard inpatients (odds ratio, 2.1), but the referral rate to other facilities on discharge was the highest in non-emergency ED patients compared with standard inpatients (odds ratio, 3.3).


      Non-emergency patients admitted to hospitals through the emergency department showed special needs for health care services: care continuity, improved access, and fast tracking for acute care hospital-level treatment. Health care policies and strategies are suggested for efficient ED functions.

      Key words

      To read this article in full you will need to make a payment


        • Richardson DB
        Increase in patient mortality at 10 days associated with emergency department overcrowding.
        Med J Aust. 2006; 184: 213-216
        • Sprivulis PC
        • Da Silva JA
        • Jacobs IG
        • Frazer AR
        • Jelinek GA
        The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments.
        Med J Aust. 2006; 184: 208-212
      1. The 2006 Statistics of Emergency Medicine. National Emergency Medical Center, Seoul2007
      2. Evaluation of Emergency Medical Centers. Korea Health Industry Development Institute, Seoul2004
        • Koziol-McLain J
        • Price DW
        • Weiss B
        • Quinn AA
        • Honigman B
        Seeking care for nonurgent medical conditions in the emergency department: Through the eyes of the patient.
        J Emerg Nurs. 2000; 26: 554-563
        • Howard MS
        • Davis BA
        • Anderson C
        • Cherry D
        • Koller P
        • Shelton D
        Patients' perspective on choosing the emergency department for nonurgent medical care: A qualitative study exploring one reason for overcrowding.
        J Emerg Nurs. 2005; 31: 429-435
        • Fatovich DM
        • Hirsch RL
        Entry overload, emergency department overcrowding, and ambulance bypass.
        Emerg Med J. 2003; 20: 406-409
        • Olshaker JS
        • Rathlev NK
        Emergency department overcrowding and ambulance diversion: The impact and potential solutions of extended boarding of admitted patients in the emergency department.
        J Emerg Med. 2006; 30: 351-356
        • Diesburg-Stanwood A
        • Scott J
        • Oman K
        • Whitehill C
        Nonemergent ED patients referred to community resources after medical screening examination: Characteristics, medical condition after 72 hours, and use of follow-up services.
        J Emerg Nurs. 2004; 30: 312-317
        • Lee G
        • Endacott R
        • Flett K
        • Bushnell R
        Characteristics of patients who did not wait for treatment in the emergency department: A follow up survey.
        Accid Emerg Nurs. 2006; 14: 56-62
        • Bentley J
        • Meyer J
        Repeat attendance by older people at accident and emergency departments.
        J Adv Nurs. 2004; 48: 149-156
        • Weber EJ
        • Showstack JA
        • Hunt KA
        • Colby DC
        • Callaham ML
        Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study.
        Ann Emerg Med. 2005; 45: 4-12


      Jee-In Hwang is Assistant Professor, Department of Nursing and Healthcare Management, College of Nursing Science, Kyung Hee University, Seoul, South Korea.


      Hyejung Chang is Associate Professor, Department of Health Services Management, College of Business Administration, Kyung Hee University, Seoul, South Korea.