Emergency physicians' and patients' assessments: urgency of need for medical care

A study was conducted under the sponsorship of the Emergency Medical Services (EMS) Committee of the American College of Emergency Physicians (ACEP) that was intended to examine prospectively patients' and physicians' perceptions of the urgency of need for medical attention. Patients presenting to the emergency departments of 24 hospitals between February 25, 1980 and March 3, 1980, were surveyed. The hospitals represented a range of geographic areas and bed capacities. At each hospital a standard data collection questionnaire was supplied to every patient presenting to the emergency department within the study period and a standard form was provided to the physician seeing each patient during the study period. A total of 10,253 forms (87% compliance) were returned and evaluated. Physicians' initial (prospective) assessments indicated that 12.6% of patients needed attention immediately (within minutes); 26.3%, urgently (within 1 to 2 hr); and 28.1%, promptly (within 2 to 12 hr). Retrospectively, reassessment by physicians indicated that 9.4% of patients needed attention immediately; 23.4%, urgently; and 29.6%, promptly. Patients' evaluations of urgency differed significantly (P < 0.05): 44.4% thought they needed care immediately; 28.5%, urgently; and 15.6%, promptly. Physicians concurred that 70% of these patients needed care within 13 hr. Twelve percent of patients rated the urgency of their condition lower than did the physicians, and 25% of patients that the physicians rated as needing immediate attention did not recognize the need for urgent care and thought they could wait from 1 hr to days. This study indicates that patients presenting to the emergency department need care more urgently than was previously supposed.