• Donna L Washington, Carl D Stevens, Paul G Shekelle, Philip L Henneman, and Robert H Brook.
• Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 111G, Los Angeles, CA 90073, USA. donna.washington@med.va.gov
• Ann. Intern. Med. 2002 Nov 5;137(9):707-14.

BackgroundBecause of overcrowding and cost-control efforts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. However, no validated systematic methods exist for safely performing such referrals.ObjectiveTo determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.DesignRandomized, controlled trial.SettingAn emergency department in a public hospital.Patients156 adults who used the emergency department on weekdays from 7:00 a.m. to 3:00 p.m. and met criteria for deferred care. The criteria applied to three symptom complexes that account for 33% of U.S. emergency department visits by adults.InterventionNext-day care at the study site's primary care center or usual same-day care.MeasurementsSelf-reported health status and use of health services during 1-week follow-up.ResultsPatients assigned to next-day care did not demonstrate clinically important disadvantages in health status or physician visits compared with usual care patients. In each group, more than 95% of patients were evaluated at least once by a physician, 4% sought health services after their initial evaluation, and no patients were hospitalized or died. At follow-up, both groups reported improved health status and fewer days in bed or with disability, although the deferred care group reported less improvement on all three measures. The 95% CIs were sufficiently narrow to exclude a clinically significant difference in self-reported health status. However, the possibility of 1 additional day in bed or with disability in the deferred care group could not be excluded.ConclusionsClinically 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.

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