title: Implementation of a hospital-integrated general practice--a successful way to reduce the burden of inappropriate emergency-department use.
abstract: BACKGROUND
  Emergency departments (EDs) are overcrowded by lower acuity patients, which might be more efficiently treated by general practitioners (GPs). This study evaluated the impact of triaging lower acuity patients to a new hospital-integrated general practice (HGP) on ED case-load and the reasons for choosing the ED/HGP.
  
  
  RESULTS
  Patients were consecutively assessed according to the emergency severity index (ESI) to triage lower acuity patients to the HGP. Consultation numbers at the emergency centre (ED and HGP) increased by 43% between 2007 (n = 16 974) and 2011 (n = 24 331) (implementation of HGP in 2009). Although self-referrals increased significantly at the emergency centre from 54% to 63% (p <0.001), the proportion of self-referrals at the ED was significantly reduced to 48% (p = 0.007). The HGP was able to reduce the burden of increasing total consultations by 36%; 4.6% were referred back to the ED after triaging to the HGP. Overall, 95% of HGP patients were self-referred, Swiss nationals (65%) and with a personal GP (82%) they attended regularly (69%). The most common reason for presenting at the emergency centre was not being able to reach the GP (60%). Diagnoses were injury- (29%) and infection- (23%) related problems affecting the musculoskeletal (27%) system and skin (21%).
  
  
  CONCLUSIONS
  The HGP succeeded in reducing the burden of inappropriate ED use: the majority of low acuity self-referred patients were conclusively treated at the HGP. The HGP does not represent competition to the GP out-of-hours care service, since the main reason for presenting at the hospital was not lacking a relationship but the GPs' inaccessibility.
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors.forename: Mathyas
authors.initials: M
authors.lastname: Wang
authors.affiliation: Emergency Department, Waid City Hospital, Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sidler
authors.affiliation: Emergency Department, Waid City Hospital, Zurich, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Eichler
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000379:methods*; D015276:Health Care Rationing / Q000379:methods; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D062072:Patient Acuity; D011446:Prospective Studies; D012017:Referral and Consultation; D013557:Switzerland; D014218:Triage / Q000379:methods; D055815:Young Adult