Robert A. Lowe, MD, MPH; K John McConnell, PhD; Stephanie B. Abbuhl, MD
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Lowe RA, McConnell KJ, Abbuhl SB. Deferred Care for Emergency Department Users with Nonacute Conditions. Ann Intern Med. 2003;139:526. doi: 10.7326/0003-4819-139-6-200309160-00019
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Published: Ann Intern Med. 2003;139(6):526.
TO THE EDITOR:
In describing a randomized trial on deferring care for emergency department users with nonacute conditions, Washington and colleagues concluded, “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” (1).
This study suffers from selection bias. Of the patients screened, 421 met deferred care criteria but only 156 (37%) were studied. When faced with the possibility of being denied emergency department care, sicker patients are more likely to decline to participate in studies like this one; 147 (35%) patients approached for Washington and colleagues' study declined. The study excluded other patients who may have been sicker, such as “patients who were taken immediately to the treatment area” and “any patient who … required a more detailed evaluation.”
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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