[Treatment of GP's telephone requests for admission. Assessment of departments for 4 medical specialties].
OBJECTIVE
To assess the capacity of 4 types of medical departments in the Paris hospital network (AP-HP) to plan hospitalization following a telephoned request from a GP (who do not have hospital admitting privileges).


METHODS
Four simulated cases were designed to present a specific problem, requiring prompt but not urgent admission into a department of internal medicine, rheumatology, gastroenterology and neurology. The experiment took place from January 17 through 12 February 2002, during standard office hours: an investigator posing as a locum tenens covering for a general practitioner called the hospital switchboard, requested the department, asked to speak to someone able to arrange the admission, and provided details of the simulated case. When a single hospital had several departments of the same specialty, we made only one telephone call. The details recorded in each case were principally the time elapsed for each stage and the final result.


RESULTS
We contacted 55 medical departments: 19 of the 20 internal medicine departments in the network, all 9 rheumatology, all 19 gastroenterology, and 8 of 13 neurology departments. The mean time spent on the phone was 5.04 min (range 1.40-10.14, SD 2.20). Justification for the referral was never questioned. Twenty-two (40%) referrals succeeded: 10/19 (53%) in internal medicine, 4/9 (44%) in rheumatology, 6/19 (32%) in gastroenterology, and 2/8 (25%) in neurology. Admission could not be arranged in 33 (60%) cases because: no one able to arrange the admission was available for 17 cases (31%) (the person was in a meeting 9 times and could not be found 8); no bed was available in 13 (24%). Alternatives solutions were proposed in 10 of these 13 cases: call the emergency unit (6/13), or call another hospital (3/13).


CONCLUSIONS
Only hospital reorganization and regular assessments can improve the procedure for handling GP referrals for admission.
Andronikof
M
M
Service des Urgences Adultes, Hôpital Antoine Béclère. marc.andronikof@abc.ap-hop-paris.fr
Thalmann
A
A
D005194:Family Practice / Q000458:organization & administration; D006760:Hospitalization / Q000706:statistics & numerical data*; D016544:Patient Simulation; D013689:Telephone