title: Appropriateness of healthdirect referrals to the emergency department compared with self-referrals and GP referrals.
abstract: OBJECTIVE
  To assess the appropriateness of healthdirect referrals to the emergency department (ED) and compare these to self-referrals and general practitioner referrals.
  
  
  METHODS
  Prospective observational study conducted at the Royal Perth Hospital ED from August 2008 to April 2009, using the healthdirect database to cross check healthdirect advice with ED data.
  
  
  METHODS
  Consecutive patients at triage, identified as healthdirect-referred, self-referred or GP-referred (720 patients per group).
  
  
  METHODS
  Appropriateness of referrals, using an a-priori definition.
  
  
  RESULTS
  The healthdirect-referred patients were significantly younger than self-referred and GP-referred patients (mean age, 41.6 years v 45.5 years and 50.1 years, respectively; P < 0.01), more likely to be female (60.3% v 43.8% and 46.4%, respectively; P < 0.01) and more likely to attend the ED out of hours (64.0% v 45.8% and 21.0%, respectively; P < 0.01). Self-referred patients had the highest acuity profile (P < 0.01). The proportions of referrals that were assessed as being appropriate were: healthdirect-referred, 72.9% (95% CI, 69.7%-76.2%); self-referred, 73.8% (95% CI, 70.5%-77.0%); and GP-referred, 89.7% (95% CI, 87.5%-91.9%). Of the 534 calls that could be traced back to the healthdirect database, 280 (52.4%) represented patients who attended the ED despite a contrary recommendation.
  
  
  CONCLUSIONS
  GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.
authors.affiliation: Royal Perth Hospital, Perth, WA.
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Ng
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: Valendar F
authors.initials: VF
authors.lastname: Turner
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Wurmel
authors.forename: Sally A
authors.initials: SA
authors.lastname: Skevington
authors.forename: Michael R
authors.initials: MR
authors.lastname: Phillips
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012648:Self Care / Q000706:statistics & numerical data*; D014904:Western Australia