scholarly journals General practitioners and emergency departments (GPED)—efficient models of care: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024012
Author(s):  
Katherine Morton ◽  
Sarah Voss ◽  
Joy Adamson ◽  
Helen Baxter ◽  
Karen Bloor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Studies ◽  
General Practitioners ◽  
Emergency Departments ◽  
Quantitative Methods ◽  
Public Involvement ◽  
Clinical Care ◽  
Urgent Care ◽  
The Uk ◽  
The Impact

IntroductionPressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.Methods and analysisThe study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.Ethics and disseminationThe study has been approved by the National Health Service East Midlands—Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation.Trial registration numberISRCTN51780222.

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.

The impact of GP referrals on overcrowding in emergency departments and acute medicine

2021 ◽  
Vol 27 (2) ◽  
pp. 1-6
Author(s):  
Ayaz A Abbasi ◽  
Shams Khan ◽  
Victor Ameh ◽  
Ilyas Muhammad
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Patient Flow ◽  
General Medicine ◽  
Service Evaluation ◽  
Urgent Care ◽  
Ambulatory Assessment ◽  
Acute Medicine ◽  
Number Of Patients ◽  
The Impact

Background/Aims A long-standing issue common to most emergency departments worldwide is overcrowding, and the UK is no exception. Overcrowding can have many adverse consequences, such as increased medical errors, decreased quality of care and poor patient outcomes. This service evaluation aimed to review the number of patients referred to acute specialties by their GPs and to evaluate the impact of these referrals on the flow of patients in and out of the emergency department and acute medicine. Methods GP referral letters were collected at an emergency department in Greater Manchester, England, between 15 May 2019 and 28 May 2019. A proforma was used by a consultant in acute medicine and a consultant in emergency medicine to evaluate each letter. Result A total of 139 GP referrals were received by the emergency department, of which 43 were to general medicine and 96 to other specialties. Of the latter, 54 cases were directed to the emergency department, 20 were directed to a different specialty and 23 did not have a specialty clearly specified. The majority of referrals were for gastrointestinal conditions or abdominal pain, with the next largest category being chest infections. Most of these patients were eventually seen in the trust's ambulatory assessment area to relieve pressure on the emergency department. Conclusions Planned and specific use of urgent care centres and ambulatory assessment areas can help to relieve pressure on emergency departments, but appropriate intervention at the primary care level is also necessary to improve patient flow.

Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration

2021 ◽  
pp. 1357633X2110248
Author(s):  
Charlie M Wray ◽  
Myla Junge ◽  
Salomeh Keyhani ◽  
Janeen E Smith
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Care Program ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Emergency Department Care ◽  
Referral Rates ◽  
Care Assessment ◽  
The Impact ◽  
Care Evaluation

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

2021 ◽  
pp. 1-3
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Urgent Care ◽  
Complex Data ◽  
University Of Washington ◽  
Primary Care Clinics ◽  
Urgent Care Centers ◽  
The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

scholarly journals Evaluating alcohol intoxication management services: the EDARA mixed-methods study

2020 ◽  
Vol 8 (24) ◽  
pp. 1-214 ◽  
Author(s):  
Simon C Moore ◽  
Davina Allen ◽  
Yvette Amos ◽  
Joanne Blake ◽  
Alan Brennan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Alcohol Intoxication ◽  
Ethnographic Study ◽  
Acute Alcohol Intoxication ◽  
Front Line ◽  
Night Time ◽  
Number Of Patients ◽  
The Impact ◽  
Management Services

Background Front-line health-care services are under increased demand when acute alcohol intoxication is most common, which is in night-time environments. Cities have implemented alcohol intoxication management services to divert the intoxicated away from emergency care. Objectives To evaluate the effectiveness, cost-effectiveness and acceptability to patients and staff of alcohol intoxication management services and undertake an ethnographic study capturing front-line staff’s views on the impact of acute alcohol intoxication on their professional lives. Methods This was a controlled mixed-methods longitudinal observational study with an ethnographic evaluation in parallel. Six cities with alcohol intoxication management services were compared with six matched control cities to determine effects on key performance indicators (e.g. number of patients in the emergency department and ambulance response times). Surveys captured the impact of alcohol intoxication management services on the quality of care for patients in six alcohol intoxication management services, six emergency departments with local alcohol intoxication management services and six emergency departments without local alcohol intoxication management services. The ethnographic study considered front-line staff perceptions in two cities with alcohol intoxication management services and one city without alcohol intoxication management services. Results Alcohol intoxication management services typically operated in cities in which the incidence of acute alcohol intoxication was greatest. The per-session average number of attendances across all alcohol intoxication management services was low (mean 7.3, average minimum 2.8, average maximum 11.8) compared with the average number of emergency department attendances per alcohol intoxication management services session (mean 78.8), and the number of patients diverted away from emergency departments, per session, required for services to be considered cost-neutral was 8.7, falling to 3.5 when ambulance costs were included. Alcohol intoxication management services varied, from volunteer-led first aid to more clinically focused nurse practitioner services, with only the latter providing evidence for diversion from emergency departments. Qualitative and ethnographic data indicated that alcohol intoxication management services are acceptable to practitioners and patients and that they address unmet need. There was evidence that alcohol intoxication management services improve ambulance response times and reduce emergency department attendance. Effects are uncertain owing to the variation in service delivery. Limitations The evaluation focused on health service outcomes, yet evidence arose suggesting that alcohol intoxication management services provide broader societal benefits. There was no nationally agreed standard operating procedure for alcohol intoxication management services, undermining the evaluation. Routine health data outcomes exhibited considerable variance, undermining opportunities to provide an accurate appraisal of the heterogenous collection of alcohol intoxication management services. Conclusions Alcohol intoxication management services are varied, multipartner endeavours and would benefit from agreed national standards. Alcohol intoxication management services are popular with and benefit front-line staff and serve as a hub facilitating partnership working. They are popular with alcohol intoxication management services patients and capture previously unmet need in night-time environments. However, acute alcohol intoxication in emergency departments remains an issue and opportunities for diversion have not been entirely realised. The nurse-led model was the most expensive service evaluated but was also the most likely to divert patients away from emergency departments, suggesting that greater clinical involvement and alignment with emergency departments is necessary. Alcohol intoxication management services should be regarded as fledgling services that require further work to realise benefit. Future work Research could be undertaken to determine if a standardised model of alcohol intoxication management services, based on the nurse practitioner model, can be developed and implemented in different settings. Future evaluations should go beyond the health service and consider outcomes more generally, especially for the police. Future work on the management of acute alcohol intoxication in night-time environments could recognise the partnership between health-care, police and ambulance services and third-sector organisations in managing acute alcohol intoxication. Trial registration Current Controlled Trials ISRCTN63096364. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 24. See the NIHR Journals Library website for further project information.

scholarly journals Political views of doctors in the UK: a cross-sectional study

2018 ◽  
Vol 72 (10) ◽  
pp. 880-887 ◽  
Author(s):  
Kate L Mandeville ◽  
Rose-Marie Satherley ◽  
Jennifer A Hall ◽  
Shailen Sutaria ◽  
Chris Willott ◽  
...  
Keyword(s):  
Online Survey ◽  
Cross Sectional Study ◽  
Urgent Care ◽  
The European Union ◽  
Left Wing ◽  
Sectional Study ◽  
Cross Sectional ◽  
Political Views ◽  
The Uk ◽  
The Impact

BackgroundLittle is known about the political views of doctors in the UK despite doctors' importance in the functioning of the National Health Service (NHS).MethodsThis is a survey-based, cross-sectional study in which we asked questions about voting behaviour in 2015 and 2017 UK general elections and 2016 referendum on leaving the European Union (EU) (Brexit), and questions relating to recent health policies.Results1172 doctors (45.1% women) from 1295 responded to an online survey. 60.5% described their political views as ‘left-wing’ and 62.2% described themselves as ‘liberal’. 79.4% of respondents voted to remain in the EU in the 2016 referendum compared with 48.1% of voters as a whole (χ2=819.8, p<0.001). 98.6% of respondents agreed that EU nationals working in the NHS should be able to remain in the UK after Brexit. The median score for the impact of Brexit on the NHS on a scale of 0 (worst impact) to 10 (best impact) was 2 (IQR=1–4). Most respondents agreed with the introduction of minimum alcohol pricing in the UK (73.9%), charging patients who are not eligible for NHS treatment for non-urgent care (70.6%) and protecting a portion of national spending for the NHS (87.1%). 65.8% thought there was too much use of NHS-funded private sector provision in their medical practice. Specialty, income and grade were associated with divergent opinions.ConclusionsUK doctors are left-leaning and liberal in general, which is reflected in their opinions on topical health policy issues. Doctors in the UK voted differently from the general electorate in recent polls.

scholarly journals A National Study of the Impact of Rapid Influenza Testing on Clinical Care in the Emergency Department

2013 ◽  
Vol 3 (2) ◽  
pp. 112-118 ◽  
Author(s):  
A. J. Blaschke ◽  
D. J. Shapiro ◽  
A. T. Pavia ◽  
C. L. Byington ◽  
K. Ampofo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Care ◽  
National Study ◽  
The Impact

Measuring impact of telephone triage in Acute Medicine

2017 ◽  
Vol 16 (3) ◽  
pp. 104-106
Author(s):  
Huma Asmat ◽  
◽  
Shah Khalid Shinwari ◽  
Timothy Cooksley ◽  
Roger Duckitt ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Emergency Departments ◽  
Local Context ◽  
Telephone Triage ◽  
Time Data ◽  
Acute Medicine ◽  
The Impact ◽  
First Time

The Society for Acute Medicine’s Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.

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