The urgency of visits to hospital emergency departments: data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), 1992.

During 1992, an estimated 89.8 million visits were made to the emergency departments (EDs) of nonfederal, short-stay or general hospitals in the United States. Of these ED visits, 40.1 million (44.6 percent) were labeled urgent by hospital staff. For survey purposes, an urgent visit was defined as one in which the patient requires immediate attention for an acute illness or injury that threatens life or function and where delay would be harmful to the patient. However, visits to hospital EDs, whether reported as urgent or nonurgent by hospital staff, may resemble each other in a number of ways. The "appropriateness" of an ED visit should not be equated solely with staff determinations of urgency, which are often made following evaluation and diagnosis rather than on the patient's presenting condition. Stomach pain was the reason most frequently given by patients for making an ED visit. These visits were reported by hospital staff to be urgent about half the time (47.5 percent of visits). The proportion of urgent visits for the most frequent reasons ranged from three-quarters of visits for chest pain and asthma to one-fifth of visits for throat symptoms and skin rash. About one-third of all ED visits (32.7 percent) received principal diagnoses within the broad category of injury and poisoning; roughly half of these visits were considered urgent. Along with injury and poisoning, diseases of the respiratory system and "signs, symptoms, and ill-defined conditions" accounted for the majority of both urgent and nonurgent ED visits. About one-quarter (24.9 percent) of urgent ED visits resulted in hospital admission. However, the most common disposition at both urgent and nonurgent ED visits was referral to another physician.