Study sheds light on non-urgent visits to emergency department

Emergency departments in the United States have more than 140 million visits every year – a rate of four visits for every 10 people – who cost almost $ 80 billion. Each interaction is carefully documented, including the reasons why the patient reports the doctor on arrival and the diagnosis of the disease or injury when the patient is dismissed.

But how often do doctors and patients agree on how serious the situation is based on what the patient says when they arrive?

Not as often as you would think. A new one, Cross-sectional research Discovered that doctors and patients agree on the urgent level of urgent level, only about 38% to 57% of the time.

The research, by Benjamin Ukert at the Texas A&M University School of Public Health and colleagues at the University of Alabama in Birmingham and University of South Carolina, was published in Jama Network Open.

“This is important because almost 40% of the Emergency Department visits are not medical emergency situations, which is financially very expensive and in terms of staff and other hospital sources,” Ukert said.

“As a result, the legislative authorities and health insurers of the state of policy have implemented policy to transfer less uriding cases to doctors and urgent care centers, but clinics stand for in-depth challenges in taking this decision based on what patients say about their condition.”

This legal process – recovery and arbitration – is based on medical claims and algorithms with regard to dismissal diagnoses and can be used to decide whether insurance pays for emergency care.

“Our findings are fundamentally challenging this plan design, because if patients and doctors give different evaluations of the urgency of the condition, then incentives to reduce first aid visits may not be effective,” Ukert said.

“For example, if patients can go to a doctor for primary care, but payment policy depends on the revision of the diagnosis and treatment of the patient after the visit to determine whether the doctor has correctly assessed the condition, this would require patients to know that their condition can be treated on a doctor instead of an emergency department.”

In order to shed light on worries about the use of retrospective assessment for urgent emergency services, the researchers characterized visits to high -level groups based on the medical urgency of the presenting reasons for visitors and to investigate the agreement between dismissal diagnoses and reasons for visitors.

They mapped all possible discharge diagnoses for the same reasons for visiting 190.7 million visits to emergency care for adults aged 18 or older between 2018 and 2019 using data from the National Hospital Ambulatory Medical Care survey.

Most patients with first aid were women (57%) and had a public health insurance policy, including Medicare (24.9%) and Medicaid (25.1%). Visits resulted in hospitalization for 13.2% of the visits.

The researchers discovered that 38.5% of the Emergency Department visits were classified with 100% certainty if the injury concerned, emergency aid required, to be treated by primary care, not urgent or related to mental health or drug use disorders, based on dismissal diagnoses. For comparison: only 0.4% was classified in the same way based on the reason that patients gave before their visit.

“In short, we found no connection between the reasons why patients at the time of arrival at an emergency department, their need for emergency care and their final dismissal diagnosis,” Ukert said.

For example, the team found that even under discharge diagnoses defined and classified as very emerging, such as strokes or heart attacks, the first reasons that were given for the visit for these conditions were also classified as emerging only 47% of the time.

“This underlines the difficulty with which doctors are confronted in making definitive assessments at triage level without first evaluating patients, since a single reason for the search for care can have multiple possible underlying causes,” Ukert said. “Alternatives for dismissal diagnoses are needed.”

He said that this could be to get additional information from patients upon arrival at the Emergency Department, such as their greatest care, symptoms and other information such as arrival mode.

“This information can lead to the development of objective tools that could more accurately assess the complexity of these visits,” Ukert said.