ORIGINAL CONTRIBUTION minor illness, emergency department use An Analysis of Emergency Department Use by Patients With Minor Illness Study objective: To describe the motivation for emergency department use by patients with minor illnesses and compare the demographics and social class characteristics of these patients with those of the general ED population. Design: Observational, case-control study. Setting: Urban ED. Type of participants: A sample group of 325 adult, nongeriatric patients with minor illnesses was selected by screening all patients registering in the ED between 9:00 AM and 6:00 PM on 15 randomly selected weekdays. A patient was included in this study group ff the chief complaint, method of arrival, and subsequent evaluation met predetermined criteria for minor illness. A comparison group (control) was composed of all ED pa- tients (224) who presented during two randomly selected 24-hour periods that did not overlap with the times of study group enrollment. Interventions: Sample group patients were interviewed concerning their socioeconomic backgrounds, reasons for using the ED, and perceptions of the urgency of their conditions. Comparison group patients' interviews were confined to the collection of demographic and socioeconomic infor- mation. Measurements and main results: There were more men (P = ,12), more self-pay patients (P = .0i 7), and fewer Medicare patients (P < .001) in the study group. There also was a strong trend toward higher income (P = .059) in the study group. The racial, marital, employment, and educa- tional backgrounds of the two groups were similar. Eighty-two percent of the study group had no chronic illness, and only 36% reported a problem of more than three days' duration. Patients chose to use the ED because of its convenience (23, 7%), the absence of previous provider relationships (22.1%), and the inability to make a prompt appointment with their regu- lar provider (/9.0%). Major differences existed between the reasons for which different demographic and socioeconomic groups chose ED care. Study group patients believed that less than 24 hours should elapse be- tween the onset of their problem and the time at which they receive medi- cal care. Conclusion: There are no major differences in ED use for minor illness patients from different racial, educational, and economic backgrounds. These patients tend to have a low frequency of chronic illness and often have no established health care provider. They choose the ED for its ease of access and the wide scope of care that can be delivered. [Shesser R, Kitsch T,, Smith J, Hirsch R: An analysis of emergency department use by patients with minor illnesses. Ann Emerg Med July i991;20:743-748.] INTRODUCTION Much has been written concerning the reasons for the increase of non- emergency patient visits to hospital emergency departments during the past four decades. TM Many studies retrospectively determined which visits were "appropriate" by reviewing ED charts and correlating the fre- quency of "inappropriate" use with the patients' socioeconomic class and access to alternative sources of health care. If patients were interviewed at all, this occurred only after the ED visit.3-6,9,14,35, 36 Several studies performed in the United States have reported on the high Robert Shesser, MD, MPH* Thomas Kirsch, MD, MPH4- Jeff Smith, MD* Robert Hirsch, PhDt Washington, DC From the Departments of Emergency Medicine* and Health Care Sciences,I- George Washington University; and the George Washington-Georgetown Emergency Medicine Residency,!: Washington, DC. Received for publication November 20, 1990. Revision received March 4, 1991. Accepted for publication March 14, 1991. Address for reprints: Robert Shesser, MD, Department of Emergency Medicine, The George Washington University Medical Center, 2140 Pennsylvania Avenue, NW, Washington, DC 20037. 20:7 July 1991 Annals of Emergency Medicine 743/61