Methods of categorizing emergency department visit urgency: A survey of pediatric emergency medicine physicians

OBJECTIVE: Between 20% and 80% of emergency department (ED) visits are nonurgent. This variability in estimates is partially due to the multiple classification methods used, none of which has undergone validity or reliability testing. Our objectives were to determine the methods thought to be most valid and to understand expert perceptions of nonurgent ED utilization. METHODS: A survey of the Pediatric Emergency Medicine (PEM) Special Interest Group at the 2005 Pediatric Academic Societies meeting was conducted. An education session with case-based discussion for categorizing ED visit urgency was presented. Six methods were reviewed: implicit criteria, explicit criteria, resource utilization, diagnoses, Current Procedural Terminology Codes, and nurse triage category. The primary outcome was the percentage of respondents ranking each method first or second best for categorizing urgency. Respondents also identified ED resources and presenting symptoms constituting an urgent visit. RESULTS: Seventy-four percent of attendees completed the survey, most were Pediatric Emergency Medicine physicians. Implicit criteria were rated highest, with 65.1% ranking it first or second, followed by explicit criteria (53.8%). With limited data available, resource utilization ranked highest (68.6%), followed by nurse triage (61.2%). There was an agreement that certain presenting symptoms and resources were adequate for determining ED visit urgency; however, there was no agreement on whether x-rays, urinalyses, or fever in a child older than 3 months was sufficient to identify urgency. CONCLUSIONS: Methods using complete medical record information are favored to determine ED visit urgency. Resource utilization and nurse triage are preferred when limited data are available. This survey will serve as the basis for endorsement of methodologically sound criteria for ED visit urgency.