Patient: “It’s an emergency!” Doctor: “No, it’s not”

Patients and doctors disagree on what is an emergency: ©Annette Shaff - stock.adobe.com

A study reveals a significant gap between how patients and emergency room doctors assess the urgency of medical conditions, with agreement occurring only 38% to 57% of the time. The research, published in the Journal of the American Medical Association, raises concerns about the effectiveness of policies aimed at reducing non-emergency visits to emergency departments.

Led by Benjamin Ukert of the Texas A&M University School of Public Health, along with colleagues from the University of Alabama at Birmingham and the University of South Carolina, the study analyzed 190.7 million ED visits among adults from 2018 and 2019. The team compared the reasons patients provided for seeking emergency care with the final discharge diagnoses documented by physicians.

“This is important because nearly 40% of emergency department visits are not medical emergencies, which is very costly financially and in terms of staffing and other hospital resources,” Ukert said. “As a result, state legislatures and health insurers have implemented policies to transfer less-urgent cases to doctors’ offices and urgent care centers, but clinicians face profound challenges in making this decision based on what patients tell them about their condition.”

One key finding of the study was the lack of correlation between a patient’s stated reason for visiting the ED and the severity of their condition as ultimately diagnosed. In cases involving severe medical emergencies such as strokes or heart attacks, the initial patient-reported reasons for seeking care were classified as emergent only 47% of the time.

“This underscores the difficulty physicians face in making definitive assessments at the triage level without first evaluating patients, given that a single reason for seeking care could have multiple possible underlying causes,” Ukert said.

The study’s findings have implications for insurance policies that use retrospective reviews to determine whether an ED visit was necessary. Under these policies, insurance companies may deny coverage for visits deemed non-emergent based on discharge diagnoses, potentially leaving patients with unexpected medical bills.

“Our findings fundamentally challenge this plan design because if patients and doctors provide different evaluations of the urgency of the condition, then incentives to reduce emergency room visits may not be effective,” Ukert said.

The researchers suggest that alternative methods for assessing patient urgency at arrival could improve decision-making. They propose collecting more detailed information from patients at check-in, such as their primary concern, symptoms, and mode of arrival, to aid in developing objective assessment tools for triage.

With emergency departments in the U.S. handling over 140 million visits annually and costing nearly $80 billion, better methods for distinguishing between emergent and non-emergent cases could significantly impact both health care costs and patient care quality, according to the report.