title: [Outpatient care in emergency departments and primary care services : A descriptive analysis of secondary data in a rural hospital].
abstract: BACKGROUND
  The use of emergency departments in German hospitals has been increasing in recent years. Emergency care provided by primary care services ("Bereitschaftsdienstpraxis") or a hospital emergency departments (EDs) is the subject of current discussions.
  
  
  OBJECTIVE
  The purpose of this study was to determine the reasons that outpatients with lower treatment urgency consult the ED. Further, the effects of the cooperation between primary care services and the ED will be examined.
  
  
  METHODS
  The study was an exploratory secondary data analysis of data from the hospital information system and a quality management survey of a basic and standard care clinic in a rural area. All patients classified as 4 and 5 according to the emergency severity index (ESI), both four weeks before and after the primary care services and ED visit, were included in the study.
  
  
  RESULTS
  During the two survey periods, a total of 1565 outpatient cases were treated, of which 962 cases (61%) were triaged ESI 4 or 5. Of these patients, 324 were surveyed (34%). Overall, 276 cases (85%) visited the ED without contacting a physician beforehand, 161 of the cases (50%) reported an emergency as the reason. In 126 cases (39%) the symptoms lasted more than one day. One-third of all outpatient admissions (537 cases, 34%) visited the ED during the opening hours of the general practitioner.
  
  
  CONCLUSIONS
  More than 80% of the surviving cases visited the ED without physician contact beforehand. The most common reason for attending the ED was, "It is an emergency." The targeted control of the patients by integrating the primary care service into the ED does not lead to an increased number of cases in the primary care service, but to a subjective relief of the ED staff.
authors.affiliation: Abteilung Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Deutschland. insa.seeger@uni-oldenburg.de.
authors.forename: I
authors.initials: I
authors.lastname: Seeger
authors.affiliation: Ubbo-Emmius-Klinik, Aurich, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Rupp
authors.affiliation: Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Naziyok
authors.affiliation: Abteilung Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Rölker-Denker
authors.affiliation: Abteilung Medizinische Informatik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Röhrig
authors.affiliation: Abteilung Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Hein
mesh_terms: D000553:Ambulatory Care; D004636:Emergency Service, Hospital; D006780:Hospitals, Rural; D006801:Humans; D011320:Primary Health Care; D014218:Triage
keywords: Emergency department; Patient survey; Primary care services; Triage ESI