Nonurgent patients routinely receive urgent care in emergency departments

Triage practices in EDs are essential to providing patient care.
Triage practices in EDs are essential to providing patient care.

Proper patient triage practices in emergency department settings is crucial to providing care to the patients who need it most, according to research published in JAMA Internal Medicine.

Renee Y Hsia, MD, MSc, of the University of California, San Francisco, and colleagues analyzed data provided by the National Hospital Ambulatory Medical Care Survey between 2009 and 2011, representing 59,293 observations over 240 million visits. The researchers found that 218.5 million visits (92.5%) were triaged as urgent; almost 17.8 million visits (7.5%) were triaged as nonurgent.

“Some patients triaged as nonurgent in emergency departments (EDs) still received diagnostic services, had procedures performed, and were admitted,” noted Dr Hsia. “Triaging patients prioritizes who most urgently needs to be seen in an ED and is essential to providing care for the sickest patients.”

Diagnostic services – including blood tests, electrocardiograms, and imaging – and procedures – including intravenous fluids, casting, and splinting – were performed in 47.6% and 32.4% of nonurgent visits, respectively. In addition, 4.4% of nonurgent visits resulted in hospital admissions; 16.2% were admissions to a critical care unit. In comparison, the researchers found that 74.8% of urgent visits received diagnostic services, 49.4% had procedures performed, and 12.8% resulted in hospital admission with 10.5% being admitted into a critical care unit.

Five of the top 10 nonurgent diagnoses are identical to diagnoses of urgent visits – backache, lumbago, acute upper respiratory infection, cellulitis, and acute pharyngitis.

“Certainly, not all of these data necessarily indicate that these services were required, and they could signal overuse or a lack of availability of primary care physicians,” said Dr Hsia. “However, to some degree, our findings indicate that either patients or healthcare professionals do entertain a degree of uncertainty that requires further evaluation before diagnosis.”

Reference

  1. Hsia RY, Friedman AB, Niedzwiecki M. Urgent care needs among nonurgent visits to the emergency department. JAMA Intern Med. 2016; doi: 10.1001/jamainternmed.2016.0878
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