Lead author Dr. Maria C. Raven of the University of California, San Francisco, and colleagues said the study highlighted the complexity of the issue by showing that using discharge diagnoses to determine the validity of an emergency room visit could have serious implications, including dissuading patients from using the ER when it was really needed.
The researchers analyzed nearly 35,000 visits to hospital emergency departments around the country.
The authors said based on their findings, if a triage nurse were to redirect patients away from the ER based on so-called non-emergency complaints, 93 percent of the patients would not have had primary care-treatable diagnoses.
"An example of the problem would be a 50-year-old patient who wakes in the middle of the night with chest pain," senior author Dr. Renee Y. Hsia of UCSF and San Francisco General Hospital & Trauma Center, said in a statement. "He goes to the emergency department and turns out, luckily, he's not having a heart attack but instead is diagnosed with acid reflux. It would be easy for a policymaker to look at his discharge diagnosis of 'acid reflux' and call that completely unnecessary, but the policymaker doesn't know that the patient actually came in with a presenting complaint of chest pain."
Raven and colleagues concluded strategies aimed at narrowly reducing use of the emergency room were unlikely to improve a community's general health or to lower healthcare costs.
The findings were published in the Journal of the American Medical Association.
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