Emergency departments in the United States are inundated with over 140 million visits each year, costing nearly $80 billion. Each visit is meticulously documented, from the patient’s initial reason for arrival to the doctor’s diagnosis upon discharge. However, a recent cross-sectional study revealed that doctors and patients only agree on the urgency level of the situation 38% to 57% of the time.
The study, conducted by Benjamin Ukert from the Texas A&M University School of Public Health, along with researchers from the University of Alabama at Birmingham and the University of South Carolina, was published in JAMA Network Open. The findings challenge the effectiveness of policies aimed at reducing non-urgent emergency department visits, as patients and doctors often have differing perceptions of the urgency of the situation.
Retrospective review and adjudication, which is commonly used to determine insurance coverage for emergency care, may not be as reliable as previously thought. The researchers analyzed data from the National Hospital Ambulatory Medical Care Survey for over 190 million emergency department visits among adults aged 18 years and older. They found that only 38.5% of visits were accurately classified based on discharge diagnoses, compared to just 0.4% based on the reasons patients provided for their visit.
The lack of concordance between patient-reported reasons for visit and discharge diagnoses highlights the challenges faced by clinicians in accurately assessing the urgency of a situation. Even visits resulting in serious conditions such as strokes or heart attacks showed discrepancies between the initial reason for the visit and the final diagnosis.
To address these issues, Ukert suggests gathering additional information from patients upon their arrival at the emergency department, such as main concerns, symptoms, and mode of arrival. This data could help develop more objective tools to assess the complexity of emergency department visits accurately.
In conclusion, the study underscores the need for alternative methods to evaluate the urgency of emergency department visits. By improving the assessment process, healthcare providers can better allocate resources and provide timely care to those in need. More research is necessary to develop effective strategies for triaging patients and improving the overall efficiency of emergency care.
