Hospital Admission Through the Emergency Department-Reply

In Reply. —I congratulate Dr Tachakra and colleagues and their medical students for devising adjustments to account for the extended hospital stays seen among patients admitted through EDs. Lack of support services for patients after hospital discharge lengthens hospital stays, and inclusion of a "disability" factor makes sense. I am somewhat surprised that the recover-ability factor was useful, as the diagnosis related group scale used by Stern et al¹to account for severity of illness includes comorbidities. The additional time and tests needed to familiarize care givers with patients admitted through EDs and the inability to use preadmission testing or to coordinate in-hospital management are other factors thought to influence the cost and duration of care for such patients.¹⁻³ Dr Hoffman describes providing facilities as alternatives to EDs for patients without urgent health problems. This would certainly ameliorate the problem of ED overcrowding, as 11% to 15% of visits