A survey of nonphysician medical screening examinations in academic emergency medicine

Objectives: To determine the proportions of U.S. emergency medicine (EM) residency programs that use nonphysicians to perform medical screening examinations (MSEs) in lieu of a physician evaluation. Methods: This was a cross-sectional observational study consisting of a mail survey of the 109 base hospitals of accredited U.S. EM residency programs. Follow-up letters were sent twice to nonrespondents. Questions regarding ED demographics, the performance and structure of MSEs by physicians and nonphysicians, and the exact, nature and purpose of such examinations were included. Results: Ninety of 109 (83%) programs responded. Eighty-seven of the 90 programs (97%) perform MSEs on all patients presenting to the ED prior to discharge. Thirty-seven percent (33/90) perform nonphysician MSEs (NPMSEs) at least some of the time. Fifty percent (16/32) refer patients to an outside facility based on the result of the screening, and in 32% of cases the patient is not offered the choice of an ED evaluation. Seventy percent (19/27) at times refer patients, including uninsured patients, to a same-day clinic within their hospital system. Seven of 27 (26%) programs performing NPMSEs reported occasional adverse events, defined as two to 11 per year. Eight of 22 (36%) reported poorer clinical outcomes than expected from ED care as a result of the NPMSE, and 18 of 25 (72%) reported some degree of patient dissatisfaction. Two programs reported death as a result of NPMSEs. Conclusions: The use of NPMSEs is common and is frequently used as a basis for referring patients away from the ED without a physician examination. Using NPMSEs may be associated with adverse events, including patient dissatisfaction, morbidity, and possibly, mortality.