Underestimation of case severity by emergency department patients

Implications for managed care

Jeffrey M. Caterinio, C. James Holliman, Allen Kunselman

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The objective was to examine differences in symptom severity assessment by emergency department (ED) patients and by emergency physicians (EPs) and to relate these assessments with case management and disposition. The design was prospective convenience sample of ED patients. The setting was a U.S. university hospital ED with an annual ED patient census 28,000. The participants were all ED patients registered when first author was in ED; excluded were patients treated by the major trauma response team and those with a psychiatric chief complaint. All patients were interviewed by the first author and asked to classify their symptoms as emergent, urgent, or nonurgent; the EP attending classed patients' symptoms at presentation and after work-up was complete. Three hundred-one cases were entered in the study from May to August 1996. Although 28% of ED patients self-rated their symptoms as nonurgent, 5% of this group required hospital admission. Of this group 35% were assessed by the EP attending as having required emergent or urgent ED care. Of this group 5% also rated by the EP initially as nonurgent had their case severity upgraded after work-up. Reliance on either patient symptom self-assessment or physician screening assessment by telephone to determine appropriateness of an ED visit is not reliably safe for at least 5% of presenting patients. Even prospective ED visit severity assessment does not reliably identify 'unnecessary' ED visits. Copyright (C) 2000 by W.B. Saunders Company.

Original languageEnglish (US)
Pages (from-to)254-256
Number of pages3
JournalAmerican Journal of Emergency Medicine
Volume18
Issue number3
StatePublished - Jan 1 2000

Fingerprint

Managed Care Programs
Hospital Emergency Service
Physicians
Emergencies
Symptom Assessment
Hospital Departments
Case Management
Emergency Medical Services
Censuses
Telephone
Psychiatry

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

@article{0fb32b58d9a94a408677b350c269a0ba,
title = "Underestimation of case severity by emergency department patients: Implications for managed care",
abstract = "The objective was to examine differences in symptom severity assessment by emergency department (ED) patients and by emergency physicians (EPs) and to relate these assessments with case management and disposition. The design was prospective convenience sample of ED patients. The setting was a U.S. university hospital ED with an annual ED patient census 28,000. The participants were all ED patients registered when first author was in ED; excluded were patients treated by the major trauma response team and those with a psychiatric chief complaint. All patients were interviewed by the first author and asked to classify their symptoms as emergent, urgent, or nonurgent; the EP attending classed patients' symptoms at presentation and after work-up was complete. Three hundred-one cases were entered in the study from May to August 1996. Although 28{\%} of ED patients self-rated their symptoms as nonurgent, 5{\%} of this group required hospital admission. Of this group 35{\%} were assessed by the EP attending as having required emergent or urgent ED care. Of this group 5{\%} also rated by the EP initially as nonurgent had their case severity upgraded after work-up. Reliance on either patient symptom self-assessment or physician screening assessment by telephone to determine appropriateness of an ED visit is not reliably safe for at least 5{\%} of presenting patients. Even prospective ED visit severity assessment does not reliably identify 'unnecessary' ED visits. Copyright (C) 2000 by W.B. Saunders Company.",
author = "Caterinio, {Jeffrey M.} and Holliman, {C. James} and Allen Kunselman",
year = "2000",
month = "1",
day = "1",
language = "English (US)",
volume = "18",
pages = "254--256",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "3",

}

Underestimation of case severity by emergency department patients : Implications for managed care. / Caterinio, Jeffrey M.; Holliman, C. James; Kunselman, Allen.

In: American Journal of Emergency Medicine, Vol. 18, No. 3, 01.01.2000, p. 254-256.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Underestimation of case severity by emergency department patients

T2 - Implications for managed care

AU - Caterinio, Jeffrey M.

AU - Holliman, C. James

AU - Kunselman, Allen

PY - 2000/1/1

Y1 - 2000/1/1

N2 - The objective was to examine differences in symptom severity assessment by emergency department (ED) patients and by emergency physicians (EPs) and to relate these assessments with case management and disposition. The design was prospective convenience sample of ED patients. The setting was a U.S. university hospital ED with an annual ED patient census 28,000. The participants were all ED patients registered when first author was in ED; excluded were patients treated by the major trauma response team and those with a psychiatric chief complaint. All patients were interviewed by the first author and asked to classify their symptoms as emergent, urgent, or nonurgent; the EP attending classed patients' symptoms at presentation and after work-up was complete. Three hundred-one cases were entered in the study from May to August 1996. Although 28% of ED patients self-rated their symptoms as nonurgent, 5% of this group required hospital admission. Of this group 35% were assessed by the EP attending as having required emergent or urgent ED care. Of this group 5% also rated by the EP initially as nonurgent had their case severity upgraded after work-up. Reliance on either patient symptom self-assessment or physician screening assessment by telephone to determine appropriateness of an ED visit is not reliably safe for at least 5% of presenting patients. Even prospective ED visit severity assessment does not reliably identify 'unnecessary' ED visits. Copyright (C) 2000 by W.B. Saunders Company.

AB - The objective was to examine differences in symptom severity assessment by emergency department (ED) patients and by emergency physicians (EPs) and to relate these assessments with case management and disposition. The design was prospective convenience sample of ED patients. The setting was a U.S. university hospital ED with an annual ED patient census 28,000. The participants were all ED patients registered when first author was in ED; excluded were patients treated by the major trauma response team and those with a psychiatric chief complaint. All patients were interviewed by the first author and asked to classify their symptoms as emergent, urgent, or nonurgent; the EP attending classed patients' symptoms at presentation and after work-up was complete. Three hundred-one cases were entered in the study from May to August 1996. Although 28% of ED patients self-rated their symptoms as nonurgent, 5% of this group required hospital admission. Of this group 35% were assessed by the EP attending as having required emergent or urgent ED care. Of this group 5% also rated by the EP initially as nonurgent had their case severity upgraded after work-up. Reliance on either patient symptom self-assessment or physician screening assessment by telephone to determine appropriateness of an ED visit is not reliably safe for at least 5% of presenting patients. Even prospective ED visit severity assessment does not reliably identify 'unnecessary' ED visits. Copyright (C) 2000 by W.B. Saunders Company.

UR - http://www.scopus.com/inward/record.url?scp=0034124304&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034124304&partnerID=8YFLogxK

M3 - Article

VL - 18

SP - 254

EP - 256

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 3

ER -