Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial

Ann Intern Med. 2002 Nov 5;137(9):707-14. doi: 10.7326/0003-4819-137-9-200211050-00005.


Background: Because 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.

Objective: To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.

Design: Randomized, controlled trial.

Setting: An emergency department in a public hospital.

Patients: 156 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.

Intervention: Next-day care at the study site's primary care center or usual same-day care.

Measurements: Self-reported health status and use of health services during 1-week follow-up.

Results: Patients 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.

Conclusions: Clinically 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Emergency Service, Hospital / organization & administration*
  • Emergency Service, Hospital / standards
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Status
  • Hospitals, Public / organization & administration*
  • Hospitals, Public / standards
  • Hospitals, Public / statistics & numerical data
  • Hospitals, Urban / organization & administration*
  • Hospitals, Urban / standards
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Los Angeles
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Primary Health Care / standards*
  • Primary Health Care / statistics & numerical data
  • Referral and Consultation*
  • Triage*