"Inappropriate" emergency department use: a comparison of three methodologies for identification.

摘要: Objective: To determine the level of agreement between rates “inappropriate” ED visits assigned to a cohort ambulatory patients based on three methods defining use appropriateness. Methods: Ambulatory adult seen at one urban, university-based teaching hospital 8 am and midnight during select days from April June 1994 were assessed regarding-the appropriateness their visits. Patients triaged acute resuscitation rooms in excluded. Eligible asked complete 90–question survey including demographics health service (response rate 81%). The was for consenting respondents by 1) application list 51 nonemergent complaints that have been used managed care providers previously published (triage), 2) ten explicit criteria (e. g., need parenteral medication) prior publications (explicit), 3) consensus two emergency physicians (EPs) reviewing records (phys). All applied time retrospective chart review. evaluated using kappa scores. Results: Of 892 eligible respondents, 64% white, 54% employed, 50% female, 29% uninsured. 26% had no regular source 25% considered care. definitions triage, 58%; phys, 47%; explicit, 42%. those deemed criteria, 81% also judged as triage 72%, phys criteria. 59% 66%, Levels (kappas) triage/explicit, 0.39; triage/phys, 0.42; explicit/phys, 0.42. Conclusion: There is only moderate different determining use. Until further refinement made assessment, organizations EPs should remain cautious when implementing protocol defines restricts