Emergency Department redirection to primary care: a prospective evaluation of practice.
Background and aim Non-urgent Emergency Department presentations contribute to overcrowding, which can adversely affect patient care. Redirecting patients to a more appropriate service is an option to help address this. We conducted a prospective evaluation of a major Scottish hospital's Emergency Department redirection policy to assess its safety. Methods and results Over two months, 620 patients triggered senior assessment for redirection with 444 (72%) redirected to primary care. Information on presentation was collected with subsequent management and outcome of redirection provided by the patient's general practitioner. Those who required admission within seven days of redirection triggered review. This was carried out independently by an Emergency Department Consultant and a GP Principal to assess the incidence of sub-optimal care or harm as a consequence of redirection. Most patients presented during daytime hours with no significant variation between days. 'Patient factors' accounted for 74% of presentations with 'convenience' (20%) cited as the most common reason. Twenty-two patients were subsequently admitted, with one case of sub-optimal care (incidence 0.23%) and no cases of harm. Conclusions Our redirection policy provides a safe and effective means of directing patients to more appropriate care. The authors believe this to be in the patient s best interest as Emergency Department clinicians are not specifically trained to manage primary care issues.
1 Specialty Registrar in Emergency Medicine, Department of Emergency Medicine, Ninewells Hospital & Medical School, Scotland, UK.
James A
JA
Bentley
1 Specialty Registrar in Emergency Medicine, Department of Emergency Medicine, Ninewells Hospital & Medical School, Scotland, UK.
Shobhan
S
Thakore
2 Consultant in Emergency Medicine, Department of Emergency Medicine, Ninewells Hospital & Medical School, Scotland, UK.
William
W
Morrison
3 Senior Lecturer, Department of Orthopaedic and Trauma Surgery, Institute of Motion Analysis and Research, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK.
Weijie
W
Wang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D012606:Scotland / Q000453:epidemiology; D014218:Triage; D055815:Young Adult
Redirect; emergency medical service; general practice; primary health care; primary health service; referral and consultation