title: Effects of a general practitioner cooperative co-located with an emergency department on patient throughput.
abstract: BACKGROUND
  In 2013 a General Practitioner Cooperative (GPC) was introduced at the Emergency Department (ED) of our hospital. One of the aims of this co-located GPC was to improve throughput of the remaining patients at the ED. To determine the change in patient flow, we assessed the number of self-referrals, redirection of self-referrals to the GPC and back to the ED, as well as ward and ICU admission rates and length of stay of the remaining ED population.
  
  
  METHODS
  We conducted a four months' pre-post comparison before and after the implementation of a co-located GPC with an urban ED in the Netherlands.
  
  
  RESULTS
  More than half of our ED patients were self-referrals. At triage, 54.5% of these self-referrals were redirected to the GPC. After assessment at the GPC, 8.5% of them were referred back to the ED. The number of patients treated at the ED declined with 20.3% after the introduction of the GPC. In the remaining ED population, there was a significant increase of highly urgent patients (P<0.001), regular admissions (P<0.001), and ICU admissions (P<0.001). Despite the decline of the number of patients at the ED, the total length of stay of patients treated at the ED increased from 14 682 hours in the two months' control period to 14 962 hours in the two months' intervention period, a total increase of 270 hours in two months (P<0.001).
  
  
  CONCLUSIONS
  Introduction of a GPC led to efficient redirection of self-referrals but failed to improve throughput of the remaining patients at the ED.
authors.affiliation: Department of Emergency Medicine, University of Botswana, School of Medicine, Gaborone, Botswana.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: van Veelen
authors.affiliation: Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Crispijn L
authors.initials: CL
authors.lastname: van den Brand
authors.affiliation: Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Resi
authors.initials: R
authors.lastname: Reijnen
authors.affiliation: Department of Emergency Medicine, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: M Christien
authors.initials: MC
authors.lastname: van der Linden
keywords: Crowding; Emergency Service; General practitioners; Length of stay; hospital