Failure to validate a predictive model for refusal of care to emergency-department patients.

A. Birnbaum, E. John Gallagher, M. Utkewicz, P. Gennis, W. Carter

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

OBJECTIVE: To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. METHODS: A convenience sample of 534 adults presenting to a municipal hospital ED between July 1, 1992, and October 15, 1992, who met preestablished criteria for refusal of care were entered into a prospective, observational, cohort study. The single target outcome variable was hospitalization. In order to optimize the criteria's performance, both the triage nurse and the physician caring for the patient had to agree that all criteria for "refusal of care" were specifically met. No patient was refused care, nor was a patient's management or disposition interfered with in any way by the investigators. All patients were followed until hospital admission or release from the ED. RESULTS: Six (1.1%) of 534 patients (95% CI 0.4-2.4) who met the criteria for refusal of care were hospitalized. This represents a greater than 50-fold difference in incidence of hospitalization when compared with that found by other investigators, who reported that only 0.02% (95% CI 0.0004-0.04) of those patients who were refused care subsequently required hospitalization (p < 10 (-7)). CONCLUSION: The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.

Original languageEnglish (US)
Pages (from-to)213-217
Number of pages5
JournalAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine
Volume1
Issue number3
StatePublished - May 1994

Fingerprint

Hospital Emergency Service
Hospitalization
Triage
Patient Care
Research Personnel
Municipal Hospitals
Hospital Departments
Observational Studies
Cohort Studies
Nurses
Guidelines
Physicians
Incidence
Population

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Failure to validate a predictive model for refusal of care to emergency-department patients. / Birnbaum, A.; Gallagher, E. John; Utkewicz, M.; Gennis, P.; Carter, W.

In: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, Vol. 1, No. 3, 05.1994, p. 213-217.

Research output: Contribution to journalArticle

@article{04276e2f7c064b81852e57baa67d80c0,
title = "Failure to validate a predictive model for refusal of care to emergency-department patients.",
abstract = "OBJECTIVE: To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. METHODS: A convenience sample of 534 adults presenting to a municipal hospital ED between July 1, 1992, and October 15, 1992, who met preestablished criteria for refusal of care were entered into a prospective, observational, cohort study. The single target outcome variable was hospitalization. In order to optimize the criteria's performance, both the triage nurse and the physician caring for the patient had to agree that all criteria for {"}refusal of care{"} were specifically met. No patient was refused care, nor was a patient's management or disposition interfered with in any way by the investigators. All patients were followed until hospital admission or release from the ED. RESULTS: Six (1.1{\%}) of 534 patients (95{\%} CI 0.4-2.4) who met the criteria for refusal of care were hospitalized. This represents a greater than 50-fold difference in incidence of hospitalization when compared with that found by other investigators, who reported that only 0.02{\%} (95{\%} CI 0.0004-0.04) of those patients who were refused care subsequently required hospitalization (p < 10 (-7)). CONCLUSION: The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.",
author = "A. Birnbaum and Gallagher, {E. John} and M. Utkewicz and P. Gennis and W. Carter",
year = "1994",
month = "5",
language = "English (US)",
volume = "1",
pages = "213--217",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Failure to validate a predictive model for refusal of care to emergency-department patients.

AU - Birnbaum, A.

AU - Gallagher, E. John

AU - Utkewicz, M.

AU - Gennis, P.

AU - Carter, W.

PY - 1994/5

Y1 - 1994/5

N2 - OBJECTIVE: To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. METHODS: A convenience sample of 534 adults presenting to a municipal hospital ED between July 1, 1992, and October 15, 1992, who met preestablished criteria for refusal of care were entered into a prospective, observational, cohort study. The single target outcome variable was hospitalization. In order to optimize the criteria's performance, both the triage nurse and the physician caring for the patient had to agree that all criteria for "refusal of care" were specifically met. No patient was refused care, nor was a patient's management or disposition interfered with in any way by the investigators. All patients were followed until hospital admission or release from the ED. RESULTS: Six (1.1%) of 534 patients (95% CI 0.4-2.4) who met the criteria for refusal of care were hospitalized. This represents a greater than 50-fold difference in incidence of hospitalization when compared with that found by other investigators, who reported that only 0.02% (95% CI 0.0004-0.04) of those patients who were refused care subsequently required hospitalization (p < 10 (-7)). CONCLUSION: The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.

AB - OBJECTIVE: To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. METHODS: A convenience sample of 534 adults presenting to a municipal hospital ED between July 1, 1992, and October 15, 1992, who met preestablished criteria for refusal of care were entered into a prospective, observational, cohort study. The single target outcome variable was hospitalization. In order to optimize the criteria's performance, both the triage nurse and the physician caring for the patient had to agree that all criteria for "refusal of care" were specifically met. No patient was refused care, nor was a patient's management or disposition interfered with in any way by the investigators. All patients were followed until hospital admission or release from the ED. RESULTS: Six (1.1%) of 534 patients (95% CI 0.4-2.4) who met the criteria for refusal of care were hospitalized. This represents a greater than 50-fold difference in incidence of hospitalization when compared with that found by other investigators, who reported that only 0.02% (95% CI 0.0004-0.04) of those patients who were refused care subsequently required hospitalization (p < 10 (-7)). CONCLUSION: The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.

UR - http://www.scopus.com/inward/record.url?scp=0028440093&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028440093&partnerID=8YFLogxK

M3 - Article

C2 - 7621199

AN - SCOPUS:0028440093

VL - 1

SP - 213

EP - 217

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 3

ER -