Time to Focus on Improving ED Value Rather Than Discouraging ED Visits

Thomas Sugarman

doi:10.5811/westjem.2013.8.19100

Abstract

Time to Focus on Improving ED Value Rather Than Discouraging ED Visits

Highlights

Policymakers, payers, and the media have focused attention on avoiding ‘inappropriate’ or ‘unnecessary’ emergency department visits.[1]
The discussion is predicated upon the ‘common knowledge’ that by diverting unnecessary emergency department (ED) visits, substantial healthcare spending will be avoided
According to NYU, the algorithm was “not intended as a triage tool or a mechanism to determine whether ED use in a specific case is ‘appropriate.’” Since the ultimate discharge diagnosis is not known at the time the patient makes the decision to visit the ED, classification based on the discharge diagnosis cannot be used to guide patients’ decision as to whether or not to use the ED

Summary

Introduction

Many of the frequently used methodologies to classify ED visits are based on the NYU ED algorithm, developed in the late 1990s to classify ED use.[4] Using expert opinion, charts were reviewed to determine if a particular visit was urgent. The algorithm was constructed to generate a probability that a particular discharge diagnosis results from a non-emergent visit. They modified the algorithm to predict non-emergent visits based upon chief complaint.

Results

Conclusion