JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial

Donna L Washington, Carl D Stevens, Paul G Shekelle, Philip L Henneman, Robert H Brook
Annals of Internal Medicine 2002 November 5, 137 (9): 707-14
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BACKGROUND: Because of overcrowding and cost-control efforts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. However, no validated systematic methods exist for safely performing such referrals.

OBJECTIVE: To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.

DESIGN: Randomized, controlled trial.

SETTING: An emergency department in a public hospital.

PATIENTS: 156 adults who used the emergency department on weekdays from 7:00 a.m. to 3:00 p.m. and met criteria for deferred care. The criteria applied to three symptom complexes that account for 33% of U.S. emergency department visits by adults.

INTERVENTION: Next-day care at the study site's primary care center or usual same-day care.

MEASUREMENTS: Self-reported health status and use of health services during 1-week follow-up.

RESULTS: Patients assigned to next-day care did not demonstrate clinically important disadvantages in health status or physician visits compared with usual care patients. In each group, more than 95% of patients were evaluated at least once by a physician, 4% sought health services after their initial evaluation, and no patients were hospitalized or died. At follow-up, both groups reported improved health status and fewer days in bed or with disability, although the deferred care group reported less improvement on all three measures. The 95% CIs were sufficiently narrow to exclude a clinically significant difference in self-reported health status. However, the possibility of 1 additional day in bed or with disability in the deferred care group could not be excluded.

CONCLUSIONS: Clinically detailed standardized screening criteria can safely identify patients at public hospital emergency departments for referral to next-day care. However, larger studies are needed to assess the possibility of adverse effects.

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