Urgency in the emergency
Online posting: May 29, 1996
Published in print: Oct. 15, 1996 (CMAJ 1996;155:275-276)
Re: Use of the emergency department for nonurgent care during regular
business hours, by Mark G. Burnett and Dr. Steven A. Grover,
CMAJ 1996; 154: 1345–1351 [abstract / résumé]
The article by Mark Burnett and Dr. Steven Grover illustrates a
major misconception about modern emergency medicine: that
nonurgent care provided in the emergency department has to be
expensive and inefficient. Williams[1] showed that there is
little difference in the cost of caring for a patient with a
nonurgent problem in an emergency department or in a family
physician's office. The issue has been the definition of "cost."
Gill[2] showed that this definition varies depending on who asks
about costs: the patient, the government, the hospital or the
emergency department.
I and my colleagues have shown[3,4] that it is possible to
provide efficient care of patients with nonurgent problems in the
emergency department. In fact, we were able to clear up the
congestion in the department by designing a system unique in
North America to treat and discharge most patients with nonurgent
problems within 1 hour of their arrival.
Before abandoning the care of patients with nonurgent
problems, we need to be aware that, for many of these patients,
the emergency department is their only source of health care. For
instance, many patients with psychosocial problems or substance-
abuse problems present with nonurgent complaints at the emergency
department because their chaotic lives make it almost impossible
for them to receive care by appointment during regular office
hours. The emergency department will remain a "safety net" for
these patients' health care, especially as alternative resources
for patients with mental illness or substance-abuse problems
continue to disappear.
Christopher M.B. Fernandes, MD, FACEP
Clinical associate professor
Department of Surgery
University of British Columbia
Vancouver, BC
cfernand@unixg.ubc.ca
References
- Williams RM: The costs of visits to emergency departments.
N Engl J Med 1996; 334: 642–646
- Gill JM: Nonurgent use of the emergency department:
Appropriate or not? Ann Emerg Med 1994; 24: 953–957
- Fernandes CMB, Christenson JM: Use of continuous quality
improvement to facilitate patient flow through the triage and
fast-track areas of an emergency department. J Emerg Med
1995; 13: 847–855
- Fernandes CMB, Christenson JM, Price A: Continuous quality
improvement reduces length of stay for fast-track patients in an
emergency department. Acad Emerg Med 1996; 3: 258–263
CMAJ email
CMAJ Readers' Forum