DO INTERNISTS AND EMERGENCY PHYSICIANS AGREE ON THE APPROPRIATENESS OF EMERGENCY DEPARTMENT VISITS

The purpose of this study was to determine the levels of agreement bet ween three methods of assessing appropriateness of emergency departmen t (ED) visits. In particular, we tested the agreement between internis ts and emergency physicians reviewing the ED nurses' triage notes, con taining information that might be available by telephone to an interni st. For 892 adult patient ED visits reviewed, we found only moderate a greement (kappa = 0.47) between these groups. In cases of disagreement , emergency physicians were 10.3 times more likely than internists to classify those with minor discharge diagnoses as appropriate for ED ca re. As managed care grows, the determination of ED appropriateness may depend on open discussions between physician groups, as well as on ac cess to timely care in office settings.