Turfing in the emergency department
2014 (English)In: EMERGENCIAS, ISSN 1137-6821, Vol. 26, no 2, 129-132 p.Article in journal (Refereed) Published
Background and objective: Turfing, defined as finding any excuse to refer a patient to a different department or team, is commonly done to avoid patient admission. Research on turfing is limited, and the practice is rarely spoken about. The author has sometimes experienced difficulty obtaining radiology images because of a stringent policy of avoiding doing such tests out of regular office hours. I suspected that physicians may present patients symptoms in ways that imply certain medical conditions, in other words to "optimize" the patient according to the criteria needed for the investigation asked for. In this study, I explored the presence and extent of turfing and optimizing in a Swedish emergency department (ED). Method: The emergency physicians (EP) at a tertiary care university hospital were invited to participate in an anonymous intranet-based survey. Demographic data collected were the physicians total experience (years), the total number of patients treated, and the experience within the present hospital (years). The EP were asked about their experience of turfing and optimizing and the percentage of patients to whom these practices were applied. The respondents were also asked how they viewed turfing and optimizing and how they thought these practices affected ED wait times. Results: Responses were received from 18 EP with a mean (SD) of 11.5 (8.48) years of total experience and of 4.4 (3.73) years in the present hospital (62% response rate). The majority had treated more than 5000 patients. All respondents confirmed the practice of turfing, and it was estimated that turfing was used in 17.34% (13.08%) of all patients (range, 2%-50%). Seventeen of the 18 respondents felt obliged to optimize patients to get tests performed, estimating that 23.23% (22.97%) of their patients were affected (range, 5%-80%). Twelve regarded turfing and optimizing to be unsafe and 17 believed that these practices influenced ED wait times. Conclusion: Turfing and optimizing, affecting approximately 1 in 5 emergency patients in this setting, seem to be major problems for the surveyed Swedish EP.
Place, publisher, year, edition, pages
SANIDAD EDICIONES , 2014. Vol. 26, no 2, 129-132 p.
Turfing; Optimizing; Emergency department; Physicians experience
Clinical Medicine Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-106123ISI: 000333001900009OAI: oai:DiVA.org:liu-106123DiVA: diva2:714043