Deferring Emergency Room Care

What is the problem and what is known about it so far?

Ideally, emergency rooms (ERs) are for people who need help right away. Last year, almost 100 million Americans visited ERs. These ERs were often overcrowded, and patients sometimes had to wait a long time. Some patients left before being seen by physicians because they felt too sick to wait. Some of these patients were hospitalized on an emergency basis within the next week.

On the other hand, many of the patients who visited ERs were not acutely or seriously ill. They used ERs rather than outpatient clinics as a principal source of care. Many had no insurance and no regular primary care doctors. We need to find alternative, safe, and acceptable ways to provide care for these patients.

Why did the researchers do this particular study?

To study the effects of deferring ER care to scheduled, next-day clinic appointments for adults with stable conditions.

Who was studied?

156 adults who came to an inner-city ER during the daytime on weekdays.

How was the study done?

The researchers developed standardized guides to identify stable patients without serious or life-threatening illnesses. The guides addressed three general problem areas that are common among adults who visit ERs (muscle and joint pains; belly and pelvic pain; and colds, sore throats, earaches, or sinus symptoms). Experienced ER nurses used the guides to identify patients with less severe illness who might be willing to be seen the next day. Patients who agreed were then randomly assigned to “deferred care” at a set time in a clinic the following day or to “usual care” (remaining in the ER for care). Seven days later, researchers called all patients and asked questions about their health, ability to function, and preferences for type of care.

What did the researchers find?

At least 95% of the patients in both groups saw a physician. Fewer than 5% sought additional care. After 1 week, patients in both groups had improved health status and ability to function. Patients who got deferred care reported slightly less improvement in health and slightly worse function than patients who received usual care. Nearly 60% in each group said they would prefer deferred care if given the choice in the future. No patients died or were hospitalized.

What were the limitations of the study?

The study was small. It involved one inner-city ER, and next-day care was readily available. It did not include patients who used the ER in the evening or during weekends.

What are the implications of the study?

Standardized guides may help nurses identify particular adults who can safely defer ER care to next-day scheduled clinic care. Although these results are promising, we need larger and longer studies involving more ERs and more diverse patients before we regularly use targeting guides for deferred care in ERs.