title: Quantifying the proportion of general practice and low-acuity patients in the emergency department.
abstract: OBJECTIVE
  To accurately estimate the proportion of patients presenting to the emergency department (ED) who may have been suitable to be seen in general practice.
  
  
  METHODS
  Using data sourced from the Emergency Department Information Systems for the calendar 2013s 2009 to 2011 at three major tertiary hospitals in Perth, Western Australia, we compared four methods for calculating general practice-type patients. These were the validated Sprivulis method, the widely used Australasian College for Emergency Medicine method, a discharge diagnosis method developed by the Tasmanian Department of Human and Health Services, and the Australian Institute of Health and Welfare (AIHW) method.
  
  
  METHODS
  General practice-type patient attendances to EDs, estimated using the four methods.
  
  
  RESULTS
  All methods except the AIHW method showed that 10%-12% of patients attending tertiary EDs in Perth may have been suitable for general practice. These attendances comprised 3%-5% of total ED length of stay. The AIHW method produced different results (general practice-type patients accounted for about 25% of attendances, comprising 10%-11% of total ED length of stay). General practice-type patient attendances were not evenly distributed across the week, with proportionally more patients presenting during weekday daytime (08:00-17:00) and proportionally fewer overnight (00:00-08:00). This suggests that it is not a lack of general practitioners that drives patients to the ED, as weekday working hours are the time of greatest GP availability.
  
  
  CONCLUSIONS
  The estimated proportion of general practice-type patients attending the EDs of Perth's major hospitals is 10%-12%, and this accounts for < 5% of the total ED length of stay. The AIHW methodology overestimates the actual proportion of general practice-type patient attendances.
authors.affiliation: School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, WA, Australia. yusuf.nagree@health.wa.gov.au
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Nagree
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Camarda
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
authors.forename: Ian
authors.initials: I
authors.lastname: Dey
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Gosbell
authors.forename: Sally M
authors.initials: SM
authors.lastname: McCarthy
authors.forename: David
authors.initials: D
authors.lastname: Mountain
mesh_terms: D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D014904:Western Australia / Q000453:epidemiology