title: Suitability of emergency department attenders to be assessed in primary care: survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project.
abstract: OBJECTIVE
  To assess the proportion of emergency department (ED) attendances that would be suitable for primary care and the inter-rater reliability of general practitioner (GP) assessment of primary care suitability.
  
  
  METHODS
  Survey of GPs' agreement of suitability for primary care on a random anonymised sample of all ED patients attending over a 1-month period.
  
  
  METHODS
  ED of a UK Hospital serving a population of 600 000.
  
  
  METHODS
  Four GPs independently used data extracted from clinical notes to rate the appropriateness for management in primary care as well as need for investigations, specialist review or admission. Agreement was assessed using Cohen's κ.
  
  
  RESULTS
  The mean percentage of patients that GPs considered suitable for primary care management was 43% (range 38-47%). The κ for agreement was 0.54 (95% CI 0.44 to 0.64) and 0.47(95% CI 0.38 to 0.59). In patients deemed not suitable for primary care, GPs were more likely to determine the need for specialist review (relative risks (RR)=3.5, 95% CI 3.0 to 4.2, p<0.001) and admission (RR=3.9, 95% CI 3.2 to 4.7, p<0.001). In patients assessed as suitable for primary care, GPs would initiate investigations in 51% of cases. Consensus over primary care appropriateness was higher for paediatric than for adult attenders.
  
  
  CONCLUSIONS
  A significant number of patients attending ED could be managed by GPs, including those requiring investigations at triage. A stronger agreement among GPs over place of care may be seen for paediatric than for adult attenders. More effective signposting of patients presenting with acute or urgent problems and supporting a greater role for primary care in relieving the severe workflow pressures in ED in the UK are potential solutions.
authors: Department of Epidemiology and Public Health, University of Exeter Medical School, Exeter, UK.
authors: Mary I W
authors: MI
authors: Thompson
authors: Daniel
authors: D
authors: Lasserson
authors: Lloyd
authors: L
authors: McCann
authors: Matthew
authors: M
authors: Thompson
authors: Carl
authors: C
authors: Heneghan
keywords: Accident & Emergency Medicine; Audit; Primary Care