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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

Features of an integrated GPC and ED (ECAP).
© Copyright Policy - open-access
Related In: Results  -  Collection


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box1: Features of an integrated GPC and ED (ECAP).

Mentions: Before the study, the ED and the GPC were located in different areas in the city, 3 kilometres apart. Although patients were encouraged to contact the GPC first, they could choose to visit the ED at their own initiative. The collaboration of the ED and the GPC to form an ECAP with one triage system in December 2008 changed this. It meant a difference in the routing of the patient after-hours because the patient could no longer willingly bypass the GP (Box 1). The ECAP is open from 5 p.m. till 8 a.m. during weekdays, the weekend, and national holidays. As before the change, patients are encouraged to phone the GPC first via a regional telephone number, when they seek medical help during ECAP hours. The after-hours change into an ECAP and the ways to contact the GP were promoted by flyers in the ED, GPC, and in waiting rooms of both the hospital and all regional GPs and by advertisements in local newspapers, prior to the implementation. A call center for the regional telephone number is colocated with the ECAP and is manned by telephone operators who are trained in using The Netherlands triage system (NTS) to determine patient urgency. NTS is a triage system that is developed and validated in The Netherlands to work for the ambulance services, GPCs, and EDs [21]. It determines the urgency, type of medical advice (consult, home visit, or telephone advice) and type of healthcare provider (ambulance, GP, or ED). A GP at the call center supervises all phone calls. Depending on the complaint and telephone triage outcome, patients will either receive a telephone advice, an appointment with a GP at the ECAP, a GP home visit or they will be directly referred to the ED. If necessary, the ECAP can send out an ambulance as well. Independently of the ECAP, there is also the national emergency phone number, 112, that patients can phone 24/7, to request an ambulance. Self-referred patients who do not phone and turn up at the ECAP are registered and triaged with NTS by a trained triage nurse. Depending on their triage outcome, patients either receive a scheduled appointment at the GPC or are directly referred to the ED. The GP supervises the triage nurse; therefore, all patients that are directly referred to the ED after triage are registered as GP referrals. Patients who have been treated by a hospital physician either in the outpatient clinic or through a hospital admission, within three months prior to presenting at the ECAP, were automatically referred to the ED and registered as a return visit. This was a local agreement between GPs and hospital physicians prior to the start of the ECAP. The GP can request simple blood tests 24/7 and X-rays until 10 p.m., without having to refer the patient to the ED, similar to office hours.


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)

Features of an integrated GPC and ED (ECAP).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

box1: Features of an integrated GPC and ED (ECAP).
Mentions: Before the study, the ED and the GPC were located in different areas in the city, 3 kilometres apart. Although patients were encouraged to contact the GPC first, they could choose to visit the ED at their own initiative. The collaboration of the ED and the GPC to form an ECAP with one triage system in December 2008 changed this. It meant a difference in the routing of the patient after-hours because the patient could no longer willingly bypass the GP (Box 1). The ECAP is open from 5 p.m. till 8 a.m. during weekdays, the weekend, and national holidays. As before the change, patients are encouraged to phone the GPC first via a regional telephone number, when they seek medical help during ECAP hours. The after-hours change into an ECAP and the ways to contact the GP were promoted by flyers in the ED, GPC, and in waiting rooms of both the hospital and all regional GPs and by advertisements in local newspapers, prior to the implementation. A call center for the regional telephone number is colocated with the ECAP and is manned by telephone operators who are trained in using The Netherlands triage system (NTS) to determine patient urgency. NTS is a triage system that is developed and validated in The Netherlands to work for the ambulance services, GPCs, and EDs [21]. It determines the urgency, type of medical advice (consult, home visit, or telephone advice) and type of healthcare provider (ambulance, GP, or ED). A GP at the call center supervises all phone calls. Depending on the complaint and telephone triage outcome, patients will either receive a telephone advice, an appointment with a GP at the ECAP, a GP home visit or they will be directly referred to the ED. If necessary, the ECAP can send out an ambulance as well. Independently of the ECAP, there is also the national emergency phone number, 112, that patients can phone 24/7, to request an ambulance. Self-referred patients who do not phone and turn up at the ECAP are registered and triaged with NTS by a trained triage nurse. Depending on their triage outcome, patients either receive a scheduled appointment at the GPC or are directly referred to the ED. The GP supervises the triage nurse; therefore, all patients that are directly referred to the ED after triage are registered as GP referrals. Patients who have been treated by a hospital physician either in the outpatient clinic or through a hospital admission, within three months prior to presenting at the ECAP, were automatically referred to the ED and registered as a return visit. This was a local agreement between GPs and hospital physicians prior to the start of the ECAP. The GP can request simple blood tests 24/7 and X-rays until 10 p.m., without having to refer the patient to the ED, similar to office hours.

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