Do Internists and Emergency Physicians Agree on the Appropriateness of Emergency Department Visits?

O'Brien, Gail M.; Shapiro, Marc J.; Fagan, Mark J.; Woolard, Robert; O’Sullivan, Patricia; Stein, Michael D.

doi:10.1007/s11606-006-5028-2

Cited by 31 publications

(3 citation statements)

References 16 publications

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“…Physicians may disagree on which ED visits are necessary, 18 nurses and physicians may not agree 19 and there may be poor correlation between methods of assessing appropriateness. 20 As well, since there is no gold standard, 21 the best method to assess appropriateness remains equivocal. Current methods include using prespecified explicit criteria, subjective, implicit criteria (e.g., "Would this patient's outcome have been worse had he or she not been seen for 24 hours?…”

Section: Discussionmentioning

confidence: 99%

The appropriateness of referrals to a pediatric emergency department via a telephone health line

Al-Abdullah

Plint

Shaw

et al. 2009

CJEM

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Objective: We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral. Methods: A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED. Results: Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p < 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes. Conclusion: There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.

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Section: Discussionmentioning

confidence: 99%

The appropriateness of referrals to a pediatric emergency department via a telephone health line

Al-Abdullah

Plint

Shaw

et al. 2009

CJEM

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“…This has revealed a dramatic divergence regarding the designation of visits as emergencies and the appropriate treatment location. 72,73 It is suggested that defining an emergency may be more a matter of physician training, specialty and belief than of science. 74…”

Section: Definitions Of Inappropriate Use Of the Emergency Departmentmentioning

confidence: 99%

“…The interpretation of this finding must be cautious, having in mind previous reports concerning lack of agreement between physicians' perceptions of what constitutes an emergency. 72,73,153 It is unknown if patients considered inappropriate by ED physicians would have been considered appropriate in PC by general practitioners. Such a design was unfeasible because of ethical and logistic concerns.…”

Section: Implications Of Study Findingsmentioning

confidence: 99%

Health care utilization following a non-urgent visit in emergency department and primary care

et al. 2010

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Unscheduled visits to an emergency department (ED) or to primary care (PC) are often followed by further healthcare contacts. Present knowledge about predisposing factors and differences between healthcare levels is sparse. The objectives of this study were to describe and to analyze factors influencing subsequent healthcare contacts within 30 days following a non-urgent ED visit or an unscheduled visit in PC. In this prospective cohort study, subjects were identified and interviewed at the time of a non-urgent ED visit or unscheduled visits to PC. Data of all healthcare contacts during 1 month were collected. The probability of reattendance was analyzed regarding socio-demographic factors, previous and present health care utilization, the physicians' perceptions of the urgency of the visit, and appropriateness of its level of care. More than half of the patients in both settings had at least one contact with healthcare the following month. In 16% of the ED patients and 9% of PC patients, these contacts were to an ED. In the multivariate analysis, patients with regular monitoring of chronic disease were associated with an increased probability of having one or more physician visit the following month (OR 1.97 CI 95% 1.15-3.36). In conclusion, previous health care utilization was associated with an increased probability of one or more further physician visits the following month, regardless of the setting for the index visit or other patients characteristics. Physicians' perception of urgency did not influence the probability of further contacts.

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The ED is an efficient place to treat ED patients

Hauswald¹

2004

The American Journal of Emergency Medicine

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Do Internists and Emergency Physicians Agree on the Appropriateness of Emergency Department Visits?

Cited by 31 publications

References 16 publications

The appropriateness of referrals to a pediatric emergency department via a telephone health line

The appropriateness of referrals to a pediatric emergency department via a telephone health line

Health care utilization following a non-urgent visit in emergency department and primary care

The ED is an efficient place to treat ED patients

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