Deferred Care for Emergency Department Users with Nonacute Conditions
Authors: Arthur L. Kellermann
Journal: Annals of Internal Medicine (2003)

Letters16 September 2003Deferred Care for Emergency Department Users with Nonacute ConditionsArthur L. Kellermann, MD, MPHArthur L. Kellermann, MD, MPHFrom Emory University; Atlanta, GA 30322.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-139-6-200309160-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Washington DL, Stevens CD, Shekelle PG, Henneman PL, Brook RH. Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial. Ann Intern Med. 2002;137:707-14. [PMID: 12416944] LinkGoogle Scholar2. Emergency departments: an essential access point to care. AHA Trendwatch. 2001;3:1-8. Google Scholar3. Young GP, Wagner MB, Kellermann AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group. JAMA. 1996;276:460-5. [PMID: 8691553] CrossrefMedlineGoogle Scholar4. Kellermann AL. Nonurgent emergency department visits. Meeting an unmet need [Editorial]. JAMA. 1994;271:1953-4. [PMID: 8201741] CrossrefMedlineGoogle Scholar5. Access of Medicaid recipients to outpatient care. N Engl J Med. 1994;330:1426-30. [PMID: 8159198] CrossrefMedlineGoogle Scholar6. EMTALA Implementation and Enforcement Issues. U.S. General Accounting Office Report to Congressional Committees. 22 June 2001. Accessed at www.gao.gov/new.items/d01747.pdf on 1 August 2003. Google Scholar7. Institute of Medicine.. Care without Coverage: Too Little, Too Late. Committee on the Consequences of Uninsurance. Washington, DC: National Academy Pr; 2002. Google Scholar8. Institute of Medicine.. Health Insurance Is a Family Matter. Committee on the Consequences of Uninsurance. Washington, DC: National Academy Pr; 2002. Google Scholar9. Institute of Medicine.. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Pr; 2002. Google Scholar10. Larson EB. Deferred care for patients in the emergency department [Editorial]. Ann Intern Med. 2002;137:764-5. [PMID: 12416950] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Emory University; Atlanta, GA 30322. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNext-Day Care for Emergency Department Users with Nonacute Conditions Donna L. Washington , Carl D. Stevens , Paul G. Shekelle , Philip L. Henneman , and Robert H. Brook Deferred Care for Patients in the Emergency Department Eric B. Larson Deferred Care for Emergency Department Users with Nonacute Conditions Donna L. Washington , Paul G. Shekelle , and Carl D. Stevens Deferred Care for Emergency Department Users with Nonacute Conditions Robert A. Lowe , K John McConnell , and Stephanie B. Abbuhl Deferred Care for Emergency Department Users with Nonacute Conditions Stephen R. Pitts Metrics 16 September 2003Volume 139, Issue 6Page: 526-528KeywordsEmergency departmentHealth careInpatientsPatientsPyelonephritisSafetySerious adverse eventsShockSpinal cordTriage ePublished: 16 September 2003 Issue Published: 16 September 2003 CopyrightCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...