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Deferred Care for Emergency Department Users with Nonacute Conditions
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TO THE EDITOR:
Because denying access to emergency department care can harm vulnerable patients, any evaluation of a deferred care strategy, such as the study by Washington and colleagues (1), should be carefully designed. Unfortunately, Washington and colleagues' study is flawed by numerous errors in concept, execution, and interpretation. First, it is based on false premises. The authors asserted that emergency department crowding is the result of patients seeking care for nonurgent problems. In fact, emergency department crowding is driven by an entirely different set of factors, most notably a nationwide decline in the number of staffed inpatient beds and a widespread shortage of nurses. This forces emergency departments to hold admitted patients in examination rooms and hallways for hours or even days until a vacant inpatient bed is available (2).
The authors claimed that “patients with nonemergency conditions often use emergency departments as portals of entry into the health care …
