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The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study.

Thijssen WA, Wijnen-van Houts M, Koetsenruijter J, Giesen P, Wensing M - Emerg Med Int (2013)

Bottom Line: Conclusion.ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up.This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients.

View Article: PubMed Central - PubMed

Affiliation: Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands ; IQ Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, IQ P.O. Box 9101, Healthcare 114, 6500HBGLO Nijmegen, The Netherlands ; Emergency Department, Catharina Hospital, Eindhoven P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands.

ABSTRACT
Introduction. A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands. This study assessed the effect on emergency department (ED) utilization and patient flows. Methods. Routinely recorded clinical ED patient data, covering a six-year period, was collected. Segmented regression analysis was used to analyze after-hours changes over time. Results. 59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%. Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002-0.004). Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%. A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870-2.071). The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013-1.017). Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246). Conclusion. ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up. This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients. Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization.

No MeSH data available.


Related in: MedlinePlus

The GP can order blood tests during ECAP hours and order X-rays until 10 p.m., without referring the patient to the ED. This is similar to office hours.
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fig1: The GP can order blood tests during ECAP hours and order X-rays until 10 p.m., without referring the patient to the ED. This is similar to office hours.

Mentions: In the Dutch healthcare system, precise numbers are lacking, but an estimated average of 1.9–2.1 million patients visited the ED per year between 2004 and 2008, with 135 treatments per 1000 inhabitants per year [9]. The GP is the coordinator of access to the hospital specialist for the majority of emergency care. Primary care is provided 24 hours a day, 7 days a week. It is always free at the point of entry, while patient copayments are required for visits to the ED. During office hours, GPs provide patient care in their office-based practices, including emergency care. Patients can contact their GP through the practice phone number for a telephone advice, a consultation or a home visit. Self-referred patients, who present to the ED during office hours and who are eligible for a GP consultation, are given the option to contact their own GP for an appointment. If they insist on receiving medical care in the ED, they are registered for treatment in the ED. The organization of after-hours primary care has changed in recent years from rota groups to GPCs, mainly to reduce GPs' workload and also to improve the quality of after-hours care. Since 2000, large-scale GPCs have emerged in the Netherlands, with around 130 GPCs serving the Dutch population of nearly 17 million inhabitants [6, 9, 10]. Nonetheless, there is a rise in self-referrals to the ED, because patients can still choose to visit the ED directly and bypass the GPC. To enhance efficiency, decrease overcrowding and costs of after-hours care by redirecting the patient that does not need hospital care to the GP, an organizational model has been proposed that integrates the GPC and the ED into a colocation with one emergency care access point (ECAP), Figure 1.


The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study.

Thijssen WA, Wijnen-van Houts M, Koetsenruijter J, Giesen P, Wensing M - Emerg Med Int (2013)

The GP can order blood tests during ECAP hours and order X-rays until 10 p.m., without referring the patient to the ED. This is similar to office hours.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3814098&req=5

fig1: The GP can order blood tests during ECAP hours and order X-rays until 10 p.m., without referring the patient to the ED. This is similar to office hours.
Mentions: In the Dutch healthcare system, precise numbers are lacking, but an estimated average of 1.9–2.1 million patients visited the ED per year between 2004 and 2008, with 135 treatments per 1000 inhabitants per year [9]. The GP is the coordinator of access to the hospital specialist for the majority of emergency care. Primary care is provided 24 hours a day, 7 days a week. It is always free at the point of entry, while patient copayments are required for visits to the ED. During office hours, GPs provide patient care in their office-based practices, including emergency care. Patients can contact their GP through the practice phone number for a telephone advice, a consultation or a home visit. Self-referred patients, who present to the ED during office hours and who are eligible for a GP consultation, are given the option to contact their own GP for an appointment. If they insist on receiving medical care in the ED, they are registered for treatment in the ED. The organization of after-hours primary care has changed in recent years from rota groups to GPCs, mainly to reduce GPs' workload and also to improve the quality of after-hours care. Since 2000, large-scale GPCs have emerged in the Netherlands, with around 130 GPCs serving the Dutch population of nearly 17 million inhabitants [6, 9, 10]. Nonetheless, there is a rise in self-referrals to the ED, because patients can still choose to visit the ED directly and bypass the GPC. To enhance efficiency, decrease overcrowding and costs of after-hours care by redirecting the patient that does not need hospital care to the GP, an organizational model has been proposed that integrates the GPC and the ED into a colocation with one emergency care access point (ECAP), Figure 1.

Bottom Line: Conclusion.ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up.This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients.

View Article: PubMed Central - PubMed

Affiliation: Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands ; IQ Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, IQ P.O. Box 9101, Healthcare 114, 6500HBGLO Nijmegen, The Netherlands ; Emergency Department, Catharina Hospital, Eindhoven P.O. Box 1350, 5602ZA NB Eindhoven, The Netherlands.

ABSTRACT
Introduction. A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands. This study assessed the effect on emergency department (ED) utilization and patient flows. Methods. Routinely recorded clinical ED patient data, covering a six-year period, was collected. Segmented regression analysis was used to analyze after-hours changes over time. Results. 59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%. Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002-0.004). Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%. A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870-2.071). The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013-1.017). Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246). Conclusion. ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up. This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients. Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization.

No MeSH data available.


Related in: MedlinePlus