Turfing in the emergency department

Martin Schilling U

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.

Martin Schilling U