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Response Dear Editor: We thank Dr. Dunford for her letter and agree with some of her points. However, we do not view medical screening examinations (MSEs) as another form of diver- sion. We only perform MSEs on patients who have been triaged to have a low acuity (non-urgent) medical problem. In our hospital, for the period we reported, 34% of visits were for low-acuity problems. Patients who present at triage and have an urgent health care problem are auto- matically sent to our main department for a complete work-up. However, having a complete work-up and even admission is no guarantee of follow-up care. The author’s assertion that a full work-up must be done on each person to ensure follow-up does not happen in today’s health care environment. What does happen is that patients spend hours in the department. Further, we do not view an MSE as a cursory once over. The providers take the patient’s history, do an examination, and provide health education. An MSE is more than a triage examination; patients with low-acuity problems are cared for in an efficient and cost-effective manner. When patients are discharged from the emergency department or the hospital, they are responsible for follow-up care. We as caring professionals need to lobby for a func- tioning, efficient community safety net. The emergency department cannot and should not try to do it all. As for the author’ s assertion that our unscheduled 72-hour return numbers could be falsely low: it is possi- ble. Yet we are the only hospital in our city. Many, if not all, of the hospitals in our surrounding counties also use MSEs. While we agree that MSEs are not the solution to ED overcrowding, it is one strategy that the caring professionals in our hospital use, knowing that the safety net of community primary and specialty providers need to do their part as well. Our institution sponsors or is actively involved in sev- eral low-cost or no-cost community clinics. —Kathleen Nash, PhD, RN, FNP, Associate Professor, University of Texas Emergency Department, University of Texas Medical Branch, Galveston, TX; E-mail: [email protected], and Melinda Tillman, MSN, RN, Systems Analyst, University of Texas Emergency Department, University of Texas Medical Branch, Galveston, TX doi: 10.1016/j.jen.2009.06.001 July 2009 35:4 JOURNAL OF EMERGENCY NURSING 281 LETTERS

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Response

Dear Editor:We thank Dr. Dunford for her letter and agree with

some of her points. However, we do not view medicalscreening examinations (MSEs) as another form of diver-sion. We only perform MSEs on patients who have beentriaged to have a low acuity (non-urgent) medical problem.In our hospital, for the period we reported, 34% of visitswere for low-acuity problems. Patients who present attriage and have an urgent health care problem are auto-matically sent to our main department for a completework-up. However, having a complete work-up and evenadmission is no guarantee of follow-up care. The author’sassertion that a full work-up must be done on each personto ensure follow-up does not happen in today’s health careenvironment. What does happen is that patients spendhours in the department.

Further, we do not view an MSE as a cursory onceover. The providers take the patient’s history, do an exami-nation, and provide health education. AnMSE is more thana triage examination; patients with low-acuity problems arecared for in an efficient and cost-effective manner.

When patients are discharged from the emergency de-partment or the hospital, they are responsible for follow-upcare. We as caring professionals need to lobby for a func-tioning, efficient community safety net. The emergency de-partment cannot and should not try to do it all.

As for the author’s assertion that our unscheduled72-hour return numbers could be falsely low: it is possi-ble. Yet we are the only hospital in our city. Many, ifnot all, of the hospitals in our surrounding counties alsouse MSEs.

While we agree that MSEs are not the solution to EDovercrowding, it is one strategy that the caring professionalsin our hospital use, knowing that the safety net of commu-nity primary and specialty providers need to do their part aswell. Our institution sponsors or is actively involved in sev-eral low-cost or no-cost community clinics.—KathleenNash, PhD, RN, FNP, Associate Professor, University ofTexas Emergency Department, University of Texas MedicalBranch, Galveston, TX; E-mail: [email protected], andMelinda Tillman, MSN, RN, Systems Analyst, Universityof Texas Emergency Department, University of Texas MedicalBranch, Galveston, TX

doi: 10.1016/j.jen.2009.06.001

July 2009 35:4 JOURNAL OF EMERGENCY NURSING 281

LETTERS

http://dx.doi.org/10.1016/j.jen.2009.06.001

mailto:[email protected]

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