title: Hospital-integrated general practice: a promising way to manage walk-in patients in emergency departments.
abstract: OBJECTIVE
  The inappropriate use and overcrowding of emergency departments (EDs) by walk-in patients are well-known problems in many countries. The current study aimed to determine whether ambulatory walk-in patients could be treated more efficiently in a new hospital-integrated general practice (HGP) for emergency care services compared to a traditional ED.
  
  
  METHODS
  We conducted a pre-post comparison before and after the implementation of a new HGP. Participants were walk-in patients attending the ED of a city hospital in Zurich. Main outcome measures were differences in total process time, time intervals between stages of care and diagnostic resources used.
  
  
  RESULTS
  The median process time from admission to discharge was 120 minutes in the ED [interquartile range (IQR): 80-165] versus 60 minutes in the HGP (IQR: 40-90) (P < 0.001). The adjusted odds ratio of receiving any additional diagnostics was 1.86 (95% confidence interval 1.06-3.27; P = 0.032) for ED doctors versus general practitioners (GPs) when controlling for patients' age, sex and injury-related medical problems.
  
  
  CONCLUSIONS
  The HGP is an efficient way to manage walk-in patients with regard to process time and utilization of additional diagnostic resources. The involvement of GPs in the HGPs should be considered as a promising model to overcome the inappropriate use of resources in EDs for walk-in patients who can be treated by ambulatory care.
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Mathyas
authors.initials: M
authors.lastname: Wang
authors.forename: Stefanie
authors.initials: S
authors.lastname: Wild
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hilfiker
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.forename: Patrick
authors.initials: P
authors.lastname: Sidler
authors.forename: Klaus
authors.initials: K
authors.lastname: Eichler
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018511:Systems Integration; D013997:Time Factors; D014218:Triage
keywords: emergency care; implementation; out-of-hours care; primary care; self-referral; walk-in patients