title: Adding a caveat to the urgent clinical notification of anaemia does not reduce inappropriate emergency room referral rates.
abstract: BACKGROUND
  Urgent clinician notification of low haemoglobin values might influence the clinicians' decision to refer patients to the emergency room (ER).
  
  
  METHODS
  We compared the effects of urgent clinician notification for low haemoglobin values with and without an added statement, that an urgent visit to the ER is not required if the patient has a haemoglobin value of 50 g/l or more and is clinically stable. We compared the referral rates and outcomes of 100 consecutive cases reported previously to that of 99 consecutive new cases with the added caveat.
  
  
  RESULTS
  Overall 47 (47%) of the historical control patients were referred to the ER compared with 45 (45.5%) in the study group (relative risk, 0.97, 95% CI, 0.72-1.3). Five patients were inappropriately transfused and almost none of the ER visits were an emergency.
  
  
  CONCLUSIONS
  Adding a caveat to the urgent clinician notification that anaemia in clinically stable patients is not a medical emergency does not decrease the rate of ER referrals. Further studies are needed in order to find ways to decrease the number of inappropriate ER referrals.
authors.affiliation: Central Laboratory of Haifa and Western Galilee, Clalit Health Services, Nesher, Israel. paulfr@clalit.org.il
authors.forename: P
authors.initials: P
authors.lastname: Froom
authors.forename: R
authors.initials: R
authors.lastname: Grikshtas
authors.forename: R
authors.initials: R
authors.lastname: Havis
authors.forename: M
authors.initials: M
authors.lastname: Barak
mesh_terms: D000740:Anemia / Q000191:economics / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins