Impact of a well-developed primary care system on the length of stay in emergency departments in the Netherlands: a multicenter study.
BACKGROUND
The Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs). In this setting, insight into crowding in EDs is limited. This study explored links between patients' ED Length of Stay (LOS) and their care pathways.


METHODS
Observational multicenter study of 7000 ED patient records from 1 February 2013. Seven EDs spread over the Netherlands, representing overall Dutch EDs, were included. This included three EDs with and four EDs without an integrated primary-care-physician (PCP) cooperative, forming one Emergency Care Access Point (ECAP). The main outcome was LOS of patients comparing different care pathways (origin and destination of ED attenders).


RESULTS
The median LOS of ED attenders was 130.0 min (IQR 79.0-140.0), which increased with patients' age. Random coefficient regression analysis showed that LOS for patients referred by medical professionals was 32.9 min longer compared to self-referred patients (95% CI 27.7-38.2 min). LOS for patients admitted to hospital was 41.2 min longer compared to patients followed-up at the outpatient clinic (95% CI 35.3-46.6 min), 49.9 min longer compared to patients followed-up at the PCP (95% CI 41.5-58.3 min) and 44.6 min longer compared to patients who did not receive follow-up (95% CI 38.3-51.0 min). There was no difference in LOS between hospitals with or without an ECAP.


CONCLUSIONS
With 130 min, the median LOS in Dutch EDs is relatively short, comparing to other Western countries, which ranges from 176 to 480 min. Although integration of EDs with out-of-hours primary care was not related to LOS, the strong primary care system probably contributed to the overall short LOS of ED patients in the Netherlands.
Emergency Department, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602ZA, Eindhoven, The Netherlands. wendy.thijssen@catharinaziekenhuis.nl.|Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands. wendy.thijssen@catharinaziekenhuis.nl.
Wendy A M H
WAMH
Thijssen
Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
Nicole
N
Kraaijvanger
Emergency Department, VieCuri Medical Center, Venlo, The Netherlands.
Dennis G
DG
Barten
Emergency Department, Elisabeth Hospital, Tilburg, The Netherlands.
Marleen L M
MLM
Boerma
Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands.
Paul
P
Giesen
Radboud University Medical Centre, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands.
Michel
M
Wensing
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003441:Crowding; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D012017:Referral and Consultation; D012044:Regression Analysis; D017678:Sex Distribution; D013997:Time Factors; D055815:Young Adult
Crowding; Emergency department; Length of stay; Primary care physician