Common reasons patients are being referred from primary to secondary care, their journey and its impact on patient flow in the Emergency Department

A longstanding issue common to all Emergency Departments (ED), worldwide, is that of crowding. In recent years, prior to the CoVid-19 pandemic this was a national problem with trolleys lined up in ED corridors and waiting rooms filled with acutely unwell patients who have only received basic triage and no other clinician assessment. Many solutions have been put forward such as the concept of “reverse queueing”, the use of urgent treatment centres [1-4] and the use of ambulatory areas, particularly for medical patients. A clearly recognized strategy in managing overcrowding in the emergency department is prehospital assessment and judicious use of secondary care by primary care colleagues. “Initial Assessment” and referral to the correct area of secondary care promotes good patient flow and directs the patient to an appropriate area of the hospital, avoiding the emergency department altogether. One of the busiest clinical specialty within most hospitals is General Medicine. This specialty generally receives twice (if not more) the referrals than any other specialties but often has the same level of staffing. We undertook an audit of a cohort of patient referred by their GPs to acute specialties over a 2-week period to see if there are lessons to be learnt in order ease pressure on the emergency department and acute medical take.