Adult health screening and referral in the emergency department.
BACKGROUND
The United States Public Health Service (USPHS) recommends using all available patient encounters to provide preventive healthcare to patients. Many studies have demonstrated the importance of performing preventive care in the emergency department (ED). These studies have used the ED as a location for patient identification and treatment, rather than as a referral site. The primary objective of this study was to identify and refer patients with unmet healthcare needs seen in the Emergency Department. A secondary objective was to determine if the patient would accept health referrals and follow-up with a doctor or clinic.


METHODS
Age and gender-specific algorithms were developed from the USPHS Clinicians' Book of Preventative Health, Second Edition. A convenience sample of patients who presented to the emergency department was asked to participate in the study to obtain 50 subjects in each age and gender grouping. After one week the patients were followed up by telephone, and after one month the computer database was queried to confirm that an appointment had been made with a doctor or clinic as recommended.


RESULTS
Three hundred and twelve patients in the Emergency Department were enrolled in the study. The demographic profile of the patients surveyed consisted of 152 (48.7%) African Americans, 81 (26.0%) Hispanics, and 12 (3.8%) Caucasians. Of those enrolled, 59.9% had a primary care physician, and 78.2% had insurance coverage. The study revealed that 28.8% of the subjects did not need a referral, 51.3% needed 1 to 3 referrals, and 19.9% needed 4 to 8 referrals. The most common needs were for tetanus immunizations (41.2%) and stool for occult blood (41.0%); the least common was for Pap smears (2.6%) and blood pressure (2.0%). Most patients accepted the referrals (88.3%), but only a fourth of those (22.6%) reported making a follow-up appointment. The appointment was confirmed in the computer system in 39.6% of the cases. The highest rate of follow-up was for prostate screening (41.4%); the least was for drug abuse (0.0%).


CONCLUSIONS
Most of the patients in this study were found to have unmet healthcare needs. Many of the patients were given referrals and followed up with the clinic or physician for the healthcare problems identified. This study reinforces the value of the USPHS guideline to use all available patient encounters for preventive healthcare.
Zun
Leslie S
LS
Department of Emergency Medicine, Finch University/Chicago Medical School, USA. zunl@sinai.org
Downey
LaVonne
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014492:United States Public Health Service