Case Study: Are There ‘Non-Emergency’ Emergency Visits?


Reduction in emergency department (ED) utilization is frequently viewed as a potential source for cost savings. One consideration has been to propose denying payment if the patient’s diagnosis upon ED discharge appears to reflect a “non-emergency” condition. This approach does not incorporate other clinical factors, such as chief complaint, that may inform necessity for ED care. This study set out to determine whether ED presenting complaint and ED discharge diagnosis correspond sufficiently to support use of discharge diagnosis as the basis for policies discouraging ED use.


We used the New York University emergency department algorithm (EDA) that has been commonly used to identify “non-emergency” ED visits. We applied the EDA to publicly available ED visit data from the 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS) for the purpose of identifying all “primary care treatable” visits. For each visit with a discharge diagnosis classified as “primary care treatable,” we identified the chief complaint. To determine whether these chief complaints correspond to “non-emergency” ED visits, we then examined all ED visits with this same group of chief complaints to ascertain the ED course, final disposition, and discharge diagnoses.


Among ED visits with the same presenting complaint as those ultimately given a “primary care treatable” diagnosis based on ED discharge diagnosis, a substantial proportion required immediate emergency care or hospital admission. The limited correspondence between presenting complaint and ED discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify ”non-emergency” ED visits.

See a video of Dr. Raven speaking about the study here.

Study Reference:
Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying “nonemergency” emergency department visits. JAMA. 2013;309(11):1145-1153. doi:10.1001/jama.2013.1948.