Background: The misuse of the Emergency Department (ED) creates a substantial problem for the health care system, generating gaps in continuity of care, leaving little room for preventative care, and forcing a financial strain on the system. An increasing number of patients are using hospital EDs for non-urgent care despite the availability of alternative care sites such as retail clinics (RCs) and urgent care centers (UCCs).

Purpose: The project’s aim was to educate patients who utilize ED services as a source of care for non-urgent complaints with the use of the D.A.N.C.E. protocol. Enhancing the public’s knowledge of the ED’s purpose and the services available at alternative care sites could provide a potential solution to ED misuse and subsequent overcrowding.

Theoretical Framework: The Andersen Framework of Health Utilization Services was used to guide this project, as it uses a systems perspective to integrate individual, environmental, and provider-related variables associated with decisions to seek care.

Methods: The D.A.N.C.E. protocol was implemented in a pilot project with the use of an educational protocol delineating functions of alternative care sites and EDs. Face validity was established by a staff consensus panel, and the protocol was then distributed to lower acuity patients discharged from the ED. At the completion of the patient’s review of the protocol, a survey card was provided evaluating which care site would be selected for the same or similar non-urgent complaint in the future and whether the protocol influenced this decision.

Results: A sample size of 22 completed surveys were returned with 55% (12) selecting the ED, 36% (8) selecting UCC/RC, and 9% (2) selecting their PCP for future care site. The majority of the surveys showed that 91% (20) of the participants found the protocol influential and 9% (2) selected the protocol had no influence on their future care site decision.

Conclusion: Despite more than half of the patients selecting the ED as their next potential source of non-urgent care, a post discharge intervention did seem to influence care site selection. Several factors presented during this project requiring further examination to better address these patients’ health care seeking behaviors.

Publication Date


Content Type



Copyright by Samantha C. Leon, 2015

All Rights Reserved

Published In:

Scholarly Project - Presented in Partial Fulfillment of the Requirements for the Degree of Doctorate of Nursing Practice - Barry University

Open Access

Available to all.