Donna L. Washington, MD, MPH; Carl D. Stevens, MD, MPH; Paul G. Shekelle, MD, PhD; Philip L. Henneman, MD; Robert H. Brook, MD, ScD
Disclaimer: The views expressed in this article are solely those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation.
Acknowledgments: The authors thank the emergency department nurses at Harbor–UCLA Medical Center for their assistance throughout the study. They also thank Martin Lee, PhD, for assistance with statistical analysis and Rachel Louie for programming support.
Grant Support: By the Robert Wood Johnson Foundation (no. 030807). Dr. Washington was a Robert Wood Johnson Foundation Minority Medical Faculty Development Program fellow at the time of the study and is currently a Research Associate of the Veterans Affairs Health Services Research and Development Service. Dr. Shekelle was a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Donna L. Washington, MD, MPH, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 111G, Los Angeles, CA 90073; e-mail, email@example.com.
Current Author Addresses: Drs. Washington and Shekelle: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 111G, Los Angeles, CA 90073.
Dr. Stevens: Department of Emergency Medicine, Harbor–UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90502.
Dr. Henneman: Department of Emergency Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.
Dr. Brook: RAND Health, 1700 Main Street, Santa Monica, CA 90407.
Author Contributions: Conception and design: D.L. Washington, C.D. Stevens, P.L. Henneman, R.H. Brook.
Analysis and interpretation of the data: D.L. Washington, C.D. Stevens, P.G. Shekelle, P.L. Henneman, R.H. Brook.
Drafting of the article: D.L. Washington, P.G. Shekelle.
Critical revision of the article for important intellectual content: D.L. Washington, C.D. Stevens, P.G. Shekelle, P.L. Henneman, R.H. Brook.
Final approval of the article: D.L. Washington, C.D. Stevens, P.G. Shekelle, P.L. Henneman, R.H. Brook.
Provision of study materials or patients: D.L. Washington, P.L. Henneman.
Statistical expertise: D.L. Washington, P.G. Shekelle.
Obtaining of funding: D.L. Washington.
Administrative, technical, or logistic support: D.L. Washington, C.D. Stevens, P.G. Shekelle, P.L. Henneman, R.H. Brook.
Collection and assembly of data: D.L. Washington.
Washington D., Stevens C., Shekelle P., Henneman P., Brook R.; Next-Day Care for Emergency Department Users with Nonacute Conditions: A Randomized, Controlled Trial. Ann Intern Med. 2002;137:707-714. doi: 10.7326/0003-4819-137-9-200211050-00005
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Published: Ann Intern Med. 2002;137(9):707-714.
In the United States, hospital emergency departments have become the principal suppliers of nonemergency care to persons with inadequate or no health insurance (1-3). However, this role as primary care provider of last resort conflicts with the primary mission of emergency departments, which is to provide timely treatment of seriously ill patients. Using emergency departments for less acute conditions may contribute substantially to overcrowding (1). Overcrowded conditions and long waiting times, in turn, prompt many patients to leave emergency departments without receiving care (4-7). In a study of 28 high-volume emergency departments in Los Angeles County, California, the proportions of patients who left before being evaluated by a physician increased fivefold as the estimated waiting times increased from less than 1 hour to more than 3 hours (7). At one large urban public hospital, more than 50% of those who left did so because they felt too sick to continue to wait (5); 11% of those who left were hospitalized emergently within the next week. Periods of emergency department saturation are increasingly common in many parts of the United States (2, 8), and overcrowding frequently results in rationed access to emergency care (9, 10).
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