Can We Use the Diagnosis to Determine Whether an ED Visit Was Necessary?

Governments, insurance companies, and even some emergency providers prefer that patients not use the emergency department (ED) for problems that are appropriate for a primary care setting. One proposed solution has been for payers to refuse to reimburse patients for ED visits with a nonserious discharge diagnosis. For this approach to make sense, presenting complaints would have to correspond to discharge diagnoses because, of course, the patient decides whether to go to the ED based on the complaint, without knowing the causative diagnosis.

Researchers analyzed data from a sample of all U.S. ED visits in 2009 to determine whether the reason for the visit differed according to whether the ultimate diagnosis represented a serious condition or…