title: Risk taking in general practice: GP out-of-hours referrals to hospital.
abstract: BACKGROUND
  Emergency admissions to hospital at night and weekends are distressing for patients and disruptive for hospitals. Many of these admissions result from referrals from GP out-of-hours (OOH) providers.
  
  
  OBJECTIVE
  To compare rates of referral to hospital for doctors working OOH before and after the new general medical services contract was introduced in Bristol in 2005; to explore the attitudes of GPs to referral to hospital OOH; and to develop an understanding of the factors that influence GPs when they refer patients to hospital.
  
  
  METHODS
  Cross-sectional comparison of admission rates; postal survey.
  
  
  METHODS
  Three OOH providers in south-west England.
  
  
  METHODS
  Referral rates were compared for 234 GPs working OOH, and questionnaires explored their attitudes to risk.
  
  
  RESULTS
  There was no change in referral rates after the change in contract or in the greater than fourfold variation between those with the lowest and highest referral rates found previously. Female GPs made fewer home visits and had a higher referral rate for patients seen at home. One-hundred and fifty GPs responded to the survey. Logistic regression of three combined survey risk items, sex, and place of visit showed that GPs with low 'tolerance of risk' scores were more likely to be high referrers to hospital (P<0.001).
  
  
  CONCLUSIONS
  GPs' threshold of risk is important for explaining variations in referral to hospital.
authors.affiliation: RDS-SW(Bristol), Education Centre, University Hospitals Bristol NHS Foundation Trust, Bristol. jenny.ingram@bristol.ac.uk
authors.forename: Jenny C
authors.initials: JC
authors.lastname: Ingram
authors.forename: Michael W
authors.initials: MW
authors.lastname: Calnan
authors.forename: Rosemary J
authors.initials: RJ
authors.lastname: Greenwood
authors.forename: Terry
authors.initials: T
authors.lastname: Kemple
authors.forename: Sarah
authors.initials: S
authors.lastname: Payne
authors.forename: Michael
authors.initials: M
authors.lastname: Rossdale
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data* / Q000639:trends; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011364:Professional Practice; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012309:Risk-Taking; D012737:Sex Factors; D011795:Surveys and Questionnaires