Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Dr. Zachary Harris

Committee Member

Dr. Julianne Ossege


BACKGROUND: Overutilization of the Emergency Department (ED) contributes to the unnecessary use of healthcare resources. One common cause is related to barriers to Primary Care access. Patients use the ED for conditions that can be managed in primary care due to the perception of urgency and convenience.

PURPOSE: The purpose of this project was to evaluate factors contributing to the use of the ED for adult patients with primary care providers (PCP). METHODS: A retrospective chart review was completed on 280 randomly selected patients over the age of 18 who presented to the ED between January and June 2018. Only those with an Emergency Severity Index (ESI) acuity level 3 or more were included. Variables assessed included patient demographics, visit characteristics, number of repeated ED visits, and number of missed PCP appointments. ED staff interviews were conducted to explore perceptions of inappropriate ED use.

RESULTS: There was a significant and positive association between the number of missed appointments with the PCP and the frequency of ED visits (r=0.151, p=0.012). This association remained significant for ED use for a different complaint (r=0.230, p

CONCLUSION: Inappropriate ED use is a multifactorial problem. It requires community effort, policy change, and accountability from patients and healthcare providers to promote appropriate health-seeking behavior