Relationship between Demographic Characteristics, Patientʼs Chief Complaint, and Medical Care Destination in an Emergency Room

The results of two studies of the Barnes Hospital Emergency Room are reported. Charts from 6,688 visits were reviewed. Demographic data, patient's chief complaint, and ultimate site of medical delivery were examined in an effort to identify interrelationships between these factors which might influence the ultimate site of medical care delivery. Two major population groups use this emergency room—one group consists predominantly of Caucasian and private patients who come from every section of the metropolitan area; the other group consists predominantly of Negro and ward patients who live in a limited area close to the hospital. In the first group, the illness was likely to be urgent and surgical in nature; in the second, nonurgent illness predominated. Ward patients were less likely to be admitted to the hospital than private patients, and, in particular, were admitted in lower proportion than they represented in the emergency room population for several chief complaint groups. The converse was true for private patients. Differences in illness patterns, medical care needs, accounted for much of this difference. The importance of hospital insurance as a gauge of financial capability and as a factor in this difference was much less than is generally thought. Selection influenced by race itself could not be ruled out as one of the several determinants of patient classification. The findings have important implications for medical care planning within and without the medical center.