scholarly journals Why do patients with minor complaints choose emergency departments and does satisfaction with primary care services influence their decisions? – CORRIGENDUM

2018 ◽  
Vol 19 (03) ◽  
pp. 316
Author(s):  
Yakup Akpinar ◽  
Hakan Demirci ◽  
Ersin Budak ◽  
Ayse Karalar Baran ◽  
Ali Candar ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Services ◽  
Primary Care Services

scholarly journals Primary care services co-located with Emergency Departments across a UK region: early views on their development

2017 ◽  
Vol 34 (10) ◽  
pp. 672-676 ◽  
Author(s):  
Suzanne Ablard ◽  
Colin O’Keeffe ◽  
Shammi Ramlakhan ◽  
Suzanne M Mason
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Services ◽  
Primary Care Services

scholarly journals Learning from diagnostic error when primary care services are located in or alongside emergency departments: a theory generating mixed-methods study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703277
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Niro Siriwardena ◽  
Adrian Edwards
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Emergency Departments ◽  
Care Service ◽  
Diagnostic Error ◽  
Learning System ◽  
Care Staff ◽  
Care Services ◽  
Primary Care Services ◽  
Service Models

BackgroundNew healthcare service models are being introduced to help manage increasing demand on emergency healthcare systems including the provision of primary care services in or alongside emergency departments. There is little research evidence to guide decisions about how service models can be most effective and safe.AimFocusing on diagnostic error, the aim was to learn why errors occur to identify priority interventions.MethodTwo data sources were used to identify diagnostic error reports including: coroners’ reports to prevent future deaths; and the National Reporting and Learning System (NRLS). A cross-sectional, mixed-methods theory-generating study which used a multi-axial PISA classification system based on the recursive model for incident analysis, was carried out.ResultsNine Coroners’ reports (from a total of 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error with learning relevant to primary care services in or alongside emergency departments. Clinical presentations included musculoskeletal injuries; unwell infants; headaches; and chest pains. Findings highlighted a difficulty identifying appropriate patients for the primary care service; underinvestigation; misinterpretation of diagnostic tests; underuse of safeguarding protocols; and inadequate communication and referral pathways between the services.ConclusionPriority areas to minimise risk of diagnostic error when primary care services are located in or alongside emergency departments include clinical decision support to triage and stream patients to the appropriate care setting; contextualised, workplace-based education and training for primary care staff; and standardised computer systems, communication and referral pathways between emergency and primary care services.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

scholarly journals Taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper

2019 ◽  
Vol 36 (10) ◽  
pp. 625-630 ◽  
Author(s):  
Alison Cooper ◽  
Michelle Edwards ◽  
Janet Brandling ◽  
Andrew Carson-Stevens ◽  
Matthew Cooke ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Service Providers ◽  
Routine Data ◽  
Emergency Department Patient ◽  
Classification Systems ◽  
Care Services ◽  
Primary Care Services ◽  
And Function

Primary care services in or alongside emergency departments look and function differently and are described using inconsistent terminology. Research to determine effectiveness of these models is hampered by outdated classification systems, limiting the opportunity for data synthesis to draw conclusions and inform decision-making and policy. We used findings from a literature review, a national survey of Type 1 emergency departments in England and Wales, staff interviews, other routine data sources and discussions from two stakeholder events to inform the taxonomy. We categorised the forms inside or outside the emergency department: inside primary care services may be integrated with emergency department patient flow or may run parallel to that activity; outside services may be offered on site or off site. We then describe a conceptual spectrum of integration: identifying constructs that influence how the services function—from being closer to an emergency medicine service or to usual primary care. This taxonomy provides a basis for future evaluation of service models that will comprise the evidence base to inform policy-making in this domain. Commissioners and service providers can consider these constructs in characterising and designing services depending on local circumstances and context.

PP18 Is there provider induced demand at emergency departments with primary care services? Patient, local and wider system factors described to influence demand for primary care in emergency departments: realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A8.2-A8
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Realist Evaluation ◽  
Urgent Care ◽  
Induced Demand ◽  
Care Services ◽  
Primary Care Services ◽  
Additional Demand ◽  
System Factors ◽  
Primary Care Clinicians

BackgroundEvidence from evaluations of emergency departments (EDs) with co-located primary care services suggests that they influence additional demand for non-urgent care (provider-induced demand). In a realist review of the literature on the effects of primary care services in EDs we proposed a theory that when primary care services are distinct at an ED they may encourage additional primary care demand and when primary care clinicians work indistinctly in the ED there is no additional demand. We aimed to explore evidence for this theory and explain contexts, mechanisms and outcomes that influence such demand.MethodsWe used realist evaluation methodology and carried out observations of key processes. We interviewed 23 patients, 21 ED clinical directors, 26 other ED staff members and 26 GPs at 13 EDs (England & Wales). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to provider induced demand.ResultsEDs with distinct primary care services were perceived to attract more demand for primary care than EDs where primary care clinicians worked indistinctly because the primary care service was visible, widely known about, enabled direct access, and received NHS 111 referrals. Other influences on demand were patients’ experiences of accessing primary care, the capacity for urgent care in the community, location of the ED and public transport links, service design and developments (new buildings, renovations) and population characteristics (unfamiliarity with local healthcare services, not registered with a GP or different cultural perceptions of seeking health care).ConclusionsA range of patient, local-system and wider-system factors contribute to additional demand at an ED with co-located primary care services. Our findings can inform providers and policymakers in developing strategies to limit the effect of these influences on additional demand.

scholarly journals 191 A classification of primary care pathways in emergency departments: a multi-methods study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews

2020 ◽  
Vol 37 (12) ◽  
pp. 841.2-842
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Davies Freya ◽  
Andrew Carson-Stevens ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Local Context ◽  
Framework Analysis ◽  
Front Door ◽  
Care Services ◽  
Primary Care Services

Aims/Objectives/BackgroundWe aim to describe and classify the predominant streaming pathways on arrival in Emergency Departments (EDs) in England and Wales and explain how they operate in different models of emergency department primary care services. Recent policy has encouraged a method whereby nurses stream from the emergency department front door to GPs working in a separate GP service operating within or alongside an ED. However, there is variation in methods of assessing and streaming patients on arrival at EDs. Conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety, clinical effectiveness. Our findings present a new classification of current streaming pathways from emergency departments to primary care services.Methods/DesignWe used a multi-stage method approach, including an online survey completed by 77 EDs across England & Wales, interviews with 21 clinical leads, and finally, undertaking case studies of 13 EDs. Qualitative data were triangulated and analysed using a framework analysis approach.Results/ConclusionsThe most common ED pathways to primary care services were: front door streaming before ED registration; streaming inside the ED; or without streaming but GPs selecting patients. Pathways were often adapted, to suit local circumstances such as department layout, patient demand levels, skill mix and interests of GPs practitioners and the accessibility of community primary care services. Pathways to redirect patients with non-urgent primary care problems to community primary care services were also used, with local variation in protocols based on staffing, patient demand and links to community primary care services. Local clinical leads and managers need to consider which pathway(s) may best suit their local context and needs. Consistency of terminology used to describe pathways between EDs and primary care services is necessary for multi-site evaluation, quality improvement and performance measurement.

scholarly journals Is streaming patients in emergency departments to primary care services effective and safe?

BMJ ◽  
2020 ◽  
pp. m462 ◽  
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Thomas Hughes ◽  
Adrian Edwards
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Care Services ◽  
Primary Care Services

scholarly journals Ontario's alternate funding arrangements for emergency departments: the impact on the emergency physician workforce

CJEM ◽  
2005 ◽  
Vol 7 (02) ◽  
pp. 100-106 ◽  
Author(s):  
Michael J. Schull ◽  
Marian Vermeulen
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Teaching Hospitals ◽  
Physician Workforce ◽  
Fee For Service ◽  
Hospital Type ◽  
Physician Staffing ◽  
Care Services ◽  
Primary Care Services ◽  
One Year

ABSTRACT Background: Difficulty maintaining physician staffing in emergency departments (EDs) prompted the government of Ontario to offer alternate funding arrangements (AFAs) to replace fee-for-service remuneration for physicians working in EDs. Objective: To analyze the effect of AFAs on physician staffing and practice patterns. Methods: We obtained Ontario Health Insurance Program fee-for-service and shadow-billing records for all physician services provided in EDs one year before and one year after implementation of an ED AFA. Only sites with reliable billing data were retained. Physicians were assigned to small/rural, community or teaching hospital groups based on their billing claims. For each hospital type, and all hospitals combined, we compared the pre- and post-AFA periods in terms of the number of physicians working regularly in the ED and their workload. As a possible unintended consequence of AFAs, we also compared physicians' involvement in primary care. Results: Overall, 76.2% of eligible hospitals adopted an ED AFA, of which 49 (42.6%) were included in our study (16 small/rural, 27 community and 6 teaching hospitals). In the post-AFA period, the number of physicians working in EDs increased by 7, from 674 to 681, representing a 1.0% increase overall in the workforce (p = 0.84). The change varied by hospital type, from a 5.8% increase in teaching hospitals to a 2.2% decrease in community hospitals, though none was significant. In the post-AFA period, the number of physicians working a moderate number of days per month increased from 190 to 214, representing a 3.2% absolute increase (p = 0.39), and the number working few (<5) or many (>10) days per month decreased. Post-AFA, the number of physicians working in EDs who also provided primary care services decreased by 1.7%, from 544 to 535 (p = 0.10). Conclusion: Emergency department AFAs have been widely adopted in Ontario, but have not been associated with substantial changes in the overall physician workforce in EDs. However, trends toward increased physician numbers were seen in small/rural and teaching hospitals. There was little evidence of any adverse effects on the provision of primary care services by physicians.

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