title: Are Grampian general practitioners good gatekeepers for access to emergency general surgical care?
abstract: BACKGROUND
  Direct admission from primary care is the predominant emergency general surgical referral route in north-east Scotland. Recent primary and secondary care reconfiguration has increased resources necessary to support the current system, therefore alternative models are proposed. We seek to analyse frequency and accuracy of provisional diagnosis by general practitioners within our current admission system.
  
  
  METHODS
  Presence of referral letter, provisional diagnosis, discharge diagnosis and management were prospectively recorded for all emergency general surgical admissions to Aberdeen Royal Infirmary over three weeks.
  
  
  RESULTS
  One hundred and sixty three primary care admissions: 69.3% from patient's own practice and 30.7% from the out-of-hours service. Of these patients 98.1% came with a referral letter, 86.1% including a provisional diagnosis, which was correct in 43.6% of cases. Fourteen patients (8.6%) were transferred to another ward for treatment.
  
  
  CONCLUSIONS
  General practitioners provide written provisional diagnoses with most referrals, accurate in almost half of cases, with only a minority of patients requiring transfer for management of presenting problems. This is despite limited investigations, clinical isolation, restricted facilities for examination and limited time for assessment. We believe Grampian general practitioners are good gatekeepers to emergency general surgical care and support the current direct admission pathway.
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill Road, Aberdeen, AB25 2ZN.
authors.forename: Al
authors.initials: A
authors.lastname: Mitchell
authors.forename: R A
authors.initials: RA
authors.lastname: Keenan
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D020793:Gatekeeping; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010821:Physicians, Family; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012606:Scotland; D013514:Surgical Procedures, Operative