Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying "Nonemergency" Emergency Department Visits

Emergency department complaints on presenting at an emergency department often do not match up with a patient’s diagnosis on discharge.

Cutting down inappropriate (nonemergency) emergency department (ED) use is an area for potential health care cost savings. Several states have legislation that limits Medicaid payments for an ED visit when the patient is sent home with a discharge diagnosis for a nonemergency.

These investigators explored the association between ED presenting complaint and ED discharge diagnosis using hospital ED data from the 2009 National Hospital Ambulatory Medical Care Survey.

After excluding visits for injuries, mental health, and drug- and alcohol-related conditions, physician reviewers coded visits as emergency or nonemergency based on chief complaint, duration of symptoms, presenting vital signs, medical history, and demographics. They further coded the “emergency” as being primary care-treatable or needing an ED. Cases were categorized as emergent or non-emergent and then further categorized. The researchers modified the widely used New York University Emergency Department algorithm to map their classifications to discharge diagnosis.

In all, they included 34,942 data sets, 6.3 percent of which had primary care-treatable diagnosis based on the ED discharge diagnosis. The presenting complaints, however, were also nonemergency complaints for 89 percent of all the ED visits, “reflecting poor correspondence between ED discharge diagnosis and chief complaint.”

Some 12.5 percent of patients with nonemergency complaints upon entry to the ED were admitted to the hospital.