High Rate of Inappropriate Utilization of an Ophthalmic Emergency Department: A Prospective Analysis of Patient Perceptions and Contributing Factors

• Published in: Medicina (Kaunas, Lithuania) Vol. 61; no. 7; p. 1163
• Main Authors: Siegel, Helena, Widmer, Vera Anna, Kammrath Betancor, Paola, Böhringer, Daniel, Reinhard, Thomas
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27.06.2025; MDPI
• Subjects: Adult; Aged; ambulatory care access; Analysis; Data analysis; Emergency medical care; Emergency service; Emergency Service, Hospital - standards; Emergency Service, Hospital - statistics & numerical data; Emergency services; eye diseases; Female; Gender; Generative artificial intelligence; Germany; Health insurance; Health insurance industry; Hospitals; Humans; inappropriate utilization; Male; Medical care; Medical societies; Medicine; Middle Aged; ophthalmic emergency care; Ophthalmology; Ophthalmology - methods; Ophthalmology - statistics & numerical data; Participation; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patient education; patient perception of urgency; Patients; Perception; Perceptions; Physicians; Practice; Prospective Studies; Questionnaires; Regression analysis; Response rates; Statistical analysis; Surveys; Surveys and Questionnaires; Trauma; triage; Utilization; Germany; healthcare-seeking behavior; ophthalmic emergency care; eye diseases; patient perception of urgency; ambulatory care access; inappropriate utilization; triage
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina61071163

Background and Objectives: In Germany, access to medical care is often hindered by long wait times for specialist appointments and emergency department care. Inappropriate utilization of emergency services further exacerbates delays for truly urgent cases. To evaluate the utilization of the statutory ophthalmic emergency service in Freiburg and identify patient- and system-level factors contributing to inappropriate use. Materials and Methods: A paper-based, anonymous questionnaire was distributed to patients attending the ophthalmologic emergency practice (Notfallpraxis) of the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), which is located within the premises of the Eye Center of the University Hospital Freiburg, Germany, at selected periods between July and September 2020, alongside a short physician assessment. Standardized instruments were used to assess symptom severity, urgency perception, and healthcare-seeking behavior. Statistical analyses were performed using R and Excel. Results: A total of 157 questionnaires were included (response rate: 63%). Most visits occurred on weekends (47%) and before 10 p.m. (83%). While 68% of patients believed their symptoms required same-day treatment, physicians assessed only 30% of cases as clinically urgent. A total of 60% of patients did not attempt to contact an outpatient ophthalmologist beforehand, and only 38% reported having a regular ophthalmologist. Patients’ perceived urgency was significantly associated with symptom severity and older age, whereas physician-assessed urgency was strongly linked to symptom duration. Conclusions: A substantial proportion of ophthalmic emergency visits in Freiburg are for non-urgent conditions. These findings underscore the need for improved coordination with outpatient care providers, better patient education, and structural reforms to reduce inappropriate utilization and ensure timely access for truly urgent cases.