The emergency department as a screening point for hospital specialty services: Inclusionary vs exclusionary strategies

Abstract

Abstract The screening function performed by the emergency department for hospital specialty units varies greatly and is important in understanding the complex relationship between emergency medical services and the wider health care environment. Two organizational postures define the extremes in screening variations. Under an Inclusionary Strategy the emergency department seeks at all costs to minimize the number of false negative cases (those that should have been referred to the specialty clinic/unit but who were incorrectly discharged from the E.R. instead) by over-referring a high level of false positives (those who should have been discharged from the emergency department but who were incorrectly referred to the specialty clinic/unit). Under an Exclusionary Strategy the emergency department does the opposite, that is, it minimizes false positive referrals by under referring and tolerating a high level of false negatives. The adoption of an Inclusionary or Exclusionary Strategy or any intermediate posture has important causes and consequences for occupancy rates of specialty units, the level of diagnostic ability required in the emergency department and therefore its clinical attractiveness for physicians, staffing ratios and training levels for nurses and physicians in the emergency department and specialty clinics/units, and the risk taking behavior of.preferring a false positive to a false negative or vice versa. Since this typology and the model on which it is based are seen as a means by which EMS research can move from observation to description and through explanation to prediction, both are used to deduce hypotheses on the causes and consequence of emergency department screening selectively for early testing of the model.