Refusing Care to Emergency Department Patients: Evaluation of Published Triage Guidelines

Study objective: To determine whether a set of published triage guidelines identifies patients who can safely be refused emergency department care. Design: Historical cohort study. Setting: A public hospital ED. Type of participants: All patients triaged during a one-week period who were not in the most acute triage category. Measurements: Two ED nurses, blinded to the study hypothesis, reviewed each triage sheet to determine whether the case met the published guidelines for refusing care. In addition, each ED record was reviewed for appropriateness; a visit was considered appropriate only if predetermined, explicit criteria were met and an emergency physician agreed that a 24-hour delay in care might have worsened the patient's outcome. Main results: Of the 106 patients who would have been refused care according to the triage guidelines, 35 (33%) had appropriate visits. Four were hospitalized. Conclusion: When tested in our patient population, the triage guidelines were not sufficiently sensitive to identify patients who needed ED care. Broad application of these guidelines may jeopardize the health of some patients. [Lowe RA, Bindman AB, UIrich SK, Norman G, Scaletta TA, Keane D, Washington D, Grumbach K: Refusing care to emergency department patients: Evaluation of published triage guidelines. Ann Emerg Med February 1994;23:286-293.]