A survey of nonphysician medical screening examinations in academic emergency medicine

Objectives: To determine the proportions of U.S. emergency medicine (EM) re sidency programs that use nonphysicians to perform medical screening examin ations (MSEs) in lieu of a physician evaluation. Methods: This was a cross- sectional observational study consisting of a mail survey of the 109 base h ospitals of accredited U.S. EM residency programs. Follow-up letters were s ent twice to nonrespondents. Questions regarding ED demographics, the perfo rmance and structure of MSEs by physicians and nonphysicians, and the exact , nature and purpose of such examinations were included. Results: Ninety of 109 (83%) programs responded. Eighty-seven of the 90 programs (97%) perfor m MSEs on all patients presenting to the ED prior to discharge. Thirty-seve n percent (33/90) perform nonphysician MSEs (NPMSEs) at least some of the t ime. Fifty percent (16/32) refer patients to an outside facility based on t he result of the screening, and in 32% of cases the patient is not offered the choice of an ED evaluation. Seventy percent (19/27) at times refer pati ents, including uninsured patients, to a same-day clinic within their hospi tal system. Seven of 27 (26%) programs performing NPMSEs reported occasiona l adverse events, defined as two to 11 per year. Eight of 22 (36%) reported poorer clinical outcomes than expected from ED care as a result of the NPM SE, and 18 of 25 (72%) reported some degree of patient dissatisfaction. Two programs reported death as a result of NPMSEs. Conclusions: The use of NPM SEs is common and is frequently used as a basis for referring patients away from the ED without a physician examination. Using NPMSEs may be associate d with adverse events, including patient dissatisfaction, morbidity, and po ssibly, mortality.