When E.R.'s Say 'Go Away'

By ERIC NAGOURNEY

y some estimates, half or more of the 100 million emergency room visits Americans make each year are for problems, like colds, that are not urgent. Misuse of the emergency system can mean that patients genuinely needing emergency care will face long waits, and sometimes go without any care.

A study released today suggests that part of the solution may lie in turning away some patients and giving them appointments the next day at a clinic. Writing in The Annals of Internal Medicine, researchers say that if patients are carefully screened, the practice appears safe.

"Deferral of care is an acceptable alternative for many patients," the authors write. "Patients with nonemergency conditions often use emergency departments as portals of entry into the health care system, not because they require immediate care.

"For these patients, a guaranteed deferred care appointment at a specified time is preferable to a long wait of uncertain length in an emergency department."

The lead researcher, Dr. Donna L. Washington of the University of California at Los Angeles, and her colleagues cautioned that more study was needed to make sure that patients would not be hurt if deferrals became widespread.

This study followed the cases of 156 adults who came to a Los Angeles emergency room, but none came in at night or on weekends. Following up a week later, researchers found roughly the same approval rate among patients treated in the emergency room and those referred to a clinic.