Effectiveness of GPs in accident and emergency departments.
BACKGROUND
Many self-attending patients make inappropriate use of accident and emergency departments.


OBJECTIVE
To determine whether a new care method consisting of the involvement of a GP during the day with the staff of the accident and emergency department of an academic city hospital and application of the Nederlands Triage System by a practice nurse is more effective than usual care.


METHODS
Before and after intervention design.


METHODS
Accident and emergency department in the VU University Medical Center in Amsterdam.


METHODS
Participants were patients (n = 1527) attending the accident and emergency department without a referral, on weekdays from 10.00-17.00 hours, from 1 November 2006 to 30 April 2007. The intervention consisted of a new care method that combined the involvement of a GP in the accident and emergency department and allocation of patients by triage to either the GP or the accident and emergency department physician. Main outcome measures were patient satisfaction, number and type of additional examinations, quality of diagnosis, process time, and treatment time.


RESULTS
Patient satisfaction with the treatment increased significantly. Compared to the usual care method, this new care method resulted in a 13% decrease in additional examinations. The percentage of incorrect diagnoses (1 %), as a measure of quality of care, was similar with the two methods. The mean process time decreased from 93 to 69 minutes (P<0.001). The mean treatment time decreased from 60 to 35 minutes (P<0.001).


CONCLUSIONS
The new care method resulted in greater patient satisfaction and maintained the quality of care, with fewer additional examinations. It reduced both the process time and the treatment time.
Boeke
A Joan P
AJ
VU University Medical Center, Department of General Practice, PO Box 7057, 1007 MB Amsterdam, The Netherlands. ajpboeke@wxs.nl
van Randwijck-Jacobze
Marguerite E
ME
de Lange-Klerk
Elly Ms
EM
Grol
Sietske M
SM
Kramer
Mark Hh
MH
van der Horst
Henriette E
HE
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014218:Triage; D055815:Young Adult