Refusing care to emergency department of patients: evaluation of published triage guidelines

To determine whether a set of published triage guidelines identifies patients who can safely be refused emergency department care.

Historical cohort study.

A public hospital ED.

All patients triaged during a one-week period who were not in the most acute triage category.

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.

Of the 106 patients who would have been refused care according to the triage guidelines, 35 (33%) had appropriate visits. Four were hospitalized.

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.