Objective: To assess the impact of the opening of an after‐hours general practice clinic on the number of daily low‐urgency presentations to the nearby emergency department. Design, participants and setting: Retrospective time series analysis of emergency presentation data, from the New South Wales Health Emergency Department Information System, for all patients presenting to the emergency department of Wagga Wagga Base Hospital between January 1998 and October 2008. Main outcome measures: Daily emergency department presentations, before and after the March 2003 opening of the after‐hours clinic, of patients triaged as Australasian Triage Scale (ATS) category 4 or 5 (at any time of day, and during the hours of operation of the clinic), and of patients triaged as ATS category 1, 2 or 3 (at any time of day). Results: After adjusting for long‐term trends and weekly and annual cycles, the opening of the after‐hours clinic was associated with a daily reduction of 7.04 patients (95% CI, 5.39–8.70) in emergency department presentations with an ATS category of 4 or 5. This represented an 8.2% reduction in total presentations (95% CI, 6.2%–10.2%). Presentations of ATS category 1, 2 or 3 patients rose by 1.36 patients a day (95% CI, 0.36–2.35), representing 1.6% of total presentations (95% CI, 0.4%–2.7%). The impact of the after‐hours clinic was best modelled by a gradual permanent change. Conclusion: An after‐hours general practice clinic was associated with a reduction in low‐urgency presentations to the emergency department in Wagga Wagga.

PurposeThe objective of this study is to investigate the existence of a diurnal pattern in the occurrence of adverse clinical management events.Design/methodology/approachThe approach takes the form of a retrospective record review of adverse clinical management events occurring in the 63 facilities of a statutory public health provider in rural south‐eastern Australia. Between January 2006 and December 2007, 2,463 clinical management incidents were reported by clinical staff to a specially designed database.FindingsAdverse clinical management incidents exhibit a marked diurnal pattern. This pattern was evident in both medicine and surgery as well as across facilities of differing acuity. The acrophase or peak of the daily cycle occurs at 14:30 hrs (95%CI 13:25 and 15:34 hrs). Although surgical events peaked earlier in the day (14.02hrs: 95%CI 12:32‐15:32) compared with medicine events (15:26hrs: 95%CI 13:07‐15:32), this difference was not statistically significant.Research limitations/implicationsAs the activity rate in the hospital is unknown, this finding study reports the time of the day when most adverse events occur and not their rate as a function of procedural volume.Practical implicationsThe existence of a diurnal pattern provides valuable information for strategies aimed at improving patient safety and health care quality. Interventions can now be more accurately targeted.Originality/valueThe paper is the first to move beyond descriptive data of the timing of adverse events and offers a model using chronobiological methods. The demonstration of the existence of diurnal patterns should improve programmes to reduce adverse events.