The emergency department is designed to handle patients with life-threatening injuries, but the vast majority also offer a helping-hand to patients whose preventive-care needs aren't being met elsewhere, such as screening for spousal abuse and giving flu shots.

A study published Monday in the Annals of Emergency Medicine found that nine out of 10 emergency departments surveyed offered at least some kind of preventive-care service, although many fall short of recommendations given by government agencies.

Even so, not everyone is pleased with the trend - close to half of ED directors worry preventive-care services drain resources better spent on acute care and could lead to worse patient outcomes.

"It's more evidence that our health-care system is dysfunctional," Dr. Kit Delgado, lead author of the study and an emergency-medicine doctor at Stanford Hospital & Clinics in Palo Alto, said in prepared remarks. "Emergency departments have evolved to compensate as the 'safety net' for patients failed by a system unable to guarantee accessible primary care."

The study was conducted through a mail-in survey answered by 277 directors of emergency departments around the country.

Most directors said their department offered at least one preventive service, but it varied widely. Screening and referral for intimate partner violence was the most commonly offered service, with around two-thirds of hospitals offering it. While high, this still fell short of national targets, the paper said.

"Our study suggests that one third of the nation's EDs may not be compliant with the Joint Commission mandate, which has required policies and procedures for intimate partner violence screening in hospitals and clinics since 1992," wrote the authors.

Screening for HIV was the least common, with only one out of five offering it, even though 2006 guidelines released by the Centers for Disease Control and Prevention called for all ED patients between 16 and 64 to be screened for the virus.

About one-third of directors said their department screened for and gave flu shots, one-fifth said they offer anti-smoking counseling and more than half offer high blood pressure screening and linkage to primary care clinics.

Yet, around 10 percent of EDs offered no services at all. The main reason for not offering them was cost, as the services are largely not reimbursable. Three-fourths of surveyed directors said cost was the biggest objection. Worries about ED overcrowding also led concerns, with around 64 percent fearing the services would increase length of stay and 53 percent concerned that resources would move away from acute care.

"Billing codes for providing ED preventive services that we studied generally do not exist," Delgado told DOTmed News by e-mail. "For example, a primary care provider can bill for smoking cessation counseling, but this cannot be done in the ED setting. Thus is there is little incentive for ED providers to do this or prescribe quit aids (such as nicotine patches), even though a patient may be there for a related problem such as asthma."

Despite the variations, less than a third of directors, 27 percent, thought the services shouldn't be offered at all.

"Our findings imply that more widespread dissemination of ED preventive services will likely be contingent on improved reimbursement," the authors concluded.

Still, the study had some limitations. The authors cautioned the results might not apply to high-volume city hospitals, which have the most at-risk patients. Also, terminology used in the survey hasn't been validated in previous research, so there's a chance each respondent could have a different interpretation of the wording.

While cost was an objection for many directors, Dr. Robert Norris, chief of emergency medicine at Stanford, said preventive-care services can save costs in the long-term along the "ounce of prevention is worth a pound of cure" principle.

"[F]or example, people who come in with an alcohol-related injury - we can discuss with them why this happened and how much worse the consequences could have been and then help to get them set up in a treatment program," he said in a statement.

But the authors believe more research is needed, as they say little work has been done to determine the cost-effectiveness of offering preventive-care services in the ED.

"ED resources are finite, and in some places EDs are so over capacity, they can barely handle getting to potential heart attack patients in the waiting room in a timely fashion," Delgado said. "Thus if we are going to invest in more preventive services, we have to make sure that they are effective in the long term, worth the cost, and that they don't hamper the EDs primary mission to provide acute care."