Outcomes of emergency room visits for XXXX . II. Relationship to admission criteria.

@entity1 @entity565 @entity1576
To learn how the outcomes of emergency room (ER) care relate to the decision-making process, criteria for the disposition of @entity565 in the ER were incorporated into a formal protocol in the form of an algorithm for use by pediatric resident physicians. We compared the application of those criteria with the consequences of 199 decisions to admit @entity1 to the hospital for @entity565 and of 293 decisions to discharge @entity1 from the ER. For most @entity1 the chance of relapse was significantly raised if they were discharged from the ER when the protocol had specified admission. This was not true, however, for a group of "frequent visitors" (12.7% of all @entity1 ) who accounted for 66.3% of all relapses. This finding offers an explanation for previous difficulties in identifying characteristics of visits destined to be followed by relapse. @entity1 were placed in jeopardy by inappropriate ER discharges only if they were high-risk @entity1 who had experienced prior episodes of @entity1576 . Nearly all admissions involving severe episodes of @entity565 were also limited to high-risk @entity1 . A variety of criteria supported such admissions. At the other extreme, "avoidable" admissions, in which obstruction resolved within a few hours of admission, occurred equally among all @entity1 strata, and no particular admission criterion could be held at fault for admission of such rapidly remitting cases. The results support the use of explicit, quantitative criteria for guiding ER disposition of @entity565 , especially specific arrangements for management of ER visits by high-risk @entity1 .(ABSTRACT TRUNCATED AT 250 WORDS)
