Background: Emergency department crowding is a growing international problem, which has
been shown to worsen clinical outcomes. One possible reason that might contribute to the crowding
problem is the rising number of “walk-in” patients presenting with non-urgent health conditions.
Methods: In a retrospective cohort study in non-surgical adult “walk-in” patients of the
emergency unit of the University Hospital Zurich, we determined the frequency of “non-urgent” medical
encounters based on the International Classification of Primary Care, examined patient characteristics
predictive for such encounters, and explored the impact of a simple triage tool on diverting “non-urgent”
encounters to alternative sites for primary care.
Results: We included 1,175 and 1,448 patient-physician encounters before (January 2008) and
after (January 2009) the implementation of the triage tool. The mean age at encounter was 45.8 (SD+18.9)
years. Men were slightly older than women (46.7 vs. 44.8 years, p=0.011). Gender was equally presented
(p=0.363). More than one half of all patients did not see a primary care provider prior to the emergency
unit visit (52.8% [95%CI 50.9-54.7%]). Almost one out of three patients presented with a minor “nonurgent”
health problem (29.9% [95%CI 28.1 -31.6%]). The most common were “cough/sneezing” (7.82%
[95%CI 6.79-8.84%]), “follow-up” (6.44% [95%CI 5.50-7.38%]), and “weakness/tiredness” (3.47% [95%CI
2.77-4.17%]). The most significant predictor for being a “non-urgent” encounter was age (adjusted odds
ratio 0.93 [95%CI 0.88-0.97, p=0.002] for each additional decade of life). Swiss patients were less likely to
present as “non-urgent” encounters (adjusted odds ratio 0.82 [95%CI 0.69-0.98], p=0.015). The
implementation of the triage tool “Light Emergency” did not effectively divert “non-urgent” cases from the
emergency unit to outpatient care (adjusted odds ratio 0.94 [95%CI 0.80-1.12, p=0.496]).
Conclusion: In Switzerland, the prevalence of “non-urgent” medical emergency unit encounters
is high with one out three patients presenting with minor “non-urgent” health problems. Young age and
non-Swiss origin is associated with increased use of the emergency unit for “non-urgent” medical
encounters. The implementation of a simple triage tool did not divert “non-urgent” cases from the medical
emergency unit to outpatient care.