[Effect of the incorporation of a general practitioner on emergency department effectiveness].
OBJECTIVE
To know the effect that the presence of a general practitioner (GP) has on emergency department's effectiveness, efficiency and health care.


METHODS
Prospective interventional study carried out in the emergency medicine unit fast track area (FTA), which is ideally opened from 8 am to 12 am, and staffed by 2 residents.


METHODS
8 resident hours (from 4 pm to 12 am) were substituted by 8 GP hours. The study period was August 2002 (GP presence), and the control period, October 2002. From each period, 10 days and 100 patients were randomly selected. From each day, FTA census (P), percentage of revisits and patients leaving without being seen, elapsed time to FTA actual closing (OT), percentage of patients moved to the observation area, and percentage of admissions were recorded. From each patient, epidemiological and clinical characteristics, waiting time to be seen (WT), number of tests performed, elapsed time to treatment (TT), and length of stay (LOS) were collected along with the number of patients finally discharged without hospital specialist consultation and those discharged with no test ordered. To assess perceived care quality, a telephone survey was performed. Three effectiveness indexes were defined and determined: P/WT (E1), P/OT (E2), and perceived care quality/perceived WT (E3). Finally, fixed and variables costs (C) from both periods were calculated, and cost-effectiveness analysis for each effectiveness index and period performed.


RESULTS
Periods showed no differences regarding daily census and patient characteristics. In the study period (GP presence), all time variables significantly improved: 20% reduction in WT, 25% in TT, 36% in LOS, and 17.5% in OT. A decrease in the number of tests ordered (41% less), in the percentage of patients moved to the observation area (78% less), and in the revisit rate (75% less) was also noted. Finally, E1 improved in 77% and E2 in 51%. Cost-effectiveness analysis clearly supported the study period, showing a decrease in C/E1 (55% less), in C/E2 (33% less), and in C/E3 (6% less). From the telephone survey, no differences between periods were detected except a perceived WT in the study period lower than that in the control period.


CONCLUSIONS
The presence of a GP in a FTA leads to an improvement in the effectiveness and quality of care received by attended patients. In addition of these important features, this presence is also efficient. Therefore, it is an intervention that could be taken into account by administrators to better manage emergency departments.
Secció d'Urgències Medicina, Area d'Urgències, Hospital Clínic, IDIBAPS, Villaroel 170, 08036 Barcelona, Spain. sjimenez@clinic.ub.es
Sònia
S
Jiménez
Gloria
G
de la Red
Oscar
O
Miró
Ernest
E
Bragulat
Blanca
B
Coll-Vinent
Esther
E
Senar
Miguel Angel
MA
Asenjo
Juan Manuel
JM
Salmerón
Miquel
M
Sánchez
D000328:Adult; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D004632:Emergency Medical Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D005194:Family Practice; D005260:Female; D006302:Health Services Research; D020445:Hospitalists; D006801:Humans; D007325:Institutional Practice; D007902:Length of Stay / Q000639:trends; D008297:Male; D011320:Primary Health Care; D011787:Quality of Health Care; D013030:Spain; D011795:Surveys and Questionnaires; D017748:Time Management