Society for Academic Emergency Medecine annual meeting - Public Health Conference on Records and Statistics. , 1993 - 1995.
The debate regarding risks and benefits of triaging nonurgent patients away from emergency departments (EDs) stems from widely varying estimates as to what proportion of ED visits are inappropriate.
A study was undertaken based on the hypothesis that these discrepant estimates might be due to differences in how « appropriateness » is defined.
This cross-sectional study included 596 ED patients.
Seven different indicators of « inappropriate » ED visits were used.
Two could be determined by the patient ; two were based on the triage nurse's assessment ; three were determined retrospectively, by chart review.
All 21 possible pairs of indicators were compared for agreement using the kappa statistic.
The proportion of ED visits classified as inappropriate by the different indicators ranged from 10% to 90%. Kappa values for agreement between indicators ranged from - 0.04 to 0.31, indicating poor agreement beyond that expected due to chance alone.
Decisions as to which ED visits are appropriate depend heavily on the criteria used.
Limiting patients'access to EDs without the aid of a valid and reliable standard for what constitutes an appropriate ED visit could create harmful barriers to care.
Mots-clés Pascal : Service hospitalier, Urgence, Utilisation, Besoin, Service santé, Evaluation, Homme, Politique sanitaire, Economie santé, Etats Unis, Amérique du Nord, Amérique, Soin intensif, Service urgence
Mots-clés Pascal anglais : Hospital ward, Emergency, Use, Need, Health service, Evaluation, Human, Health policy, Health economy, United States, North America, America, Intensive care, Emergency departement
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0289085
Code Inist : 002B30A04B. Création : 15/07/1997.