Ambulance dispatch versus general practitioner home visit for highly urgent out-of-hours primary care

Plat, F.M.; Peters, Yonne; Loots, Feike J; Groot, C. J. A. De; Eckhardt, Thomas; Keizer, Ellen; Giesen, Paul

doi:10.1093/fampra/cmx121

Cited by 18 publications

(18 citation statements)

References 22 publications

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“…In addition, patients do not always expect a physical encounter with the attending physician and in some cases a telephone advice su ces. From earlier research, we know that referrals by this operator happen safe and adequate to all levels of care (9,(17)(18)(19)(20). Increasing the adequacy of referring will undoubtedly decrease the patient in ow for unplanned care, workload and waiting lists.…”

Section: Discussionmentioning

confidence: 97%

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Schoenmakers

Criekinge

Boeve

et al. 2020

Preprint

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Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of inappropriate emergency visits. Although this system is well organised, the number of inappropriate visits does not decrease. Methods We explored the position of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services, including patients and physicians. Main outcome measures were the position of patients and physician on co-location a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favored a co-location. The most important advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GP’s and 38 (95%) of the emergency physicians were in favor of a co-location. The major advantage of this system was a more adequate referral of patients. 254 (79%) of the GP’s and 23 (83%) of the emergency physicians believed that a co-location would lower the workload, decrease waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To meet all concerns and to reach for high care quality information campaigns and development of workflows are necessary for a successful implementation of a co-location of primary and emergency care.

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Section: Discussionmentioning

confidence: 97%

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Schoenmakers

Criekinge

Boeve

et al. 2020

Preprint

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“…Only 1% of all calls were referred to planned care. This low number is mainly due to a lack of experience with this care level, which did not exist before 1733 (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

“…Under triage may result in an unsafe situation (8,10,12). The number of under-triage was mainly caused by referral to 'out of hours primary care services' instead of 'urgent home visit'.…”

Section: Discussionmentioning

confidence: 99%

The implementation of the nationwide out of hours phone number 1733. Analysis of efficiency and safety.

Delmeiren

Pietermans

Janssens

et al. 2020

Preprint

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Background In Belgium there is a problem with improper use of emergency services. The government installed an emergency number 1733 for out of hours care. Through a dry run test we learned that 10% of all calls were allocated to the protocol ‘unclear problem’. In only 10% of all cases, there was indeed an unclear problem.Methods This study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the specific primary care protocols. The study was performed in a retrospective and prospective design and involved the community, patients, General Practitioner Cooperatives, emergency departments and telephone operators.Results During 6 months in 2018, 11622 calls to 1733 were registered. 756 of these calls were allocated to ‘unwell for no clear reason’. A random sample of 180 calls was re-listened. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved. The safety levels for under- and over-triage were not exceeded. The GP’s on duty judged that 9/10 of all patient encounters were correctly allocated. In less than 1% of all referrals, there was an under-triage.Conclusion This study demonstrated that the implementation of a 1733-operating system to triage patients to an adequate care level is successful if protocols, flow charts and care levels are well defined and operators well trained.

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“…It is the most common reason for allocating an ambulance within 15 min (U1) to patients calling OHS-PC (60.7% of all dispatches), but only around 10% actually have an ACS . [11][12][13] The aim of our study was to assess the accuracy of telephone triage for patients with chest discomfort who call the OHS-PC with the clinical outcome ACS/other LTE as the reference. Both the accuracy of the NTS tool and the 'final' urgency, including overruling by the triage nurses, were evaluated.…”

Section: Key Questionsmentioning

confidence: 99%

Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

Wouters¹,

Rutten²,

Erkelens³

et al. 2020

Open Heart

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ObjectiveTo assess the accuracy of semi-automatic assisted telephone triage in patients with acute chest discomfort against the diagnosis of acute coronary syndrome (ACS) or other life-threatening events (LTEs).MethodsA cross-sectional study was performed of telephone conversations with 2023 patients with acute chest discomfort (pain, pressure, tightness or discomfort) who called out-of-hours services for primary care (OHS-PC) between 2014 and 2016. Sensitivity, specificity, positive and negative predicted values were calculated for a high urgency (patient seen within one hour) against the diagnoses of ACS and other LTEs. Diagnoses were retrieved from the patients' medical records in general practice, including hospital specialists' discharge letters.ResultsOf 2023 patients who called because of chest discomfort, 227 (11.2%) had an ACS (men 14.9%, women 8.2%) and 58 (2.9%) had another LTE (men 3.6%, women 2.3%). The sensitivity and specificity of a high Netherlands Triage System (NTS) urgency allocation against ACS/other LTEs were 0.73 (95% CI 0.68 to 0.78) and 0.43 (95% CI 0.40 to 0.45), respectively. In 13.2% of the calls the triage nurse overruled the NTS urgency, mostly by upscaling (11.0%). The sensitivity and specificity of the final urgency allocation were 0.86 (95% CI 0.81 to 0.90) and 0.34 (95% CI 0.32 to 0.37). The positive and negative predictive values of the final urgency were 0.18 (95% CI 0.17 to 0.19) and 0.94 (95% CI 0.92 to 0.95), respectively.ConclusionsThe semi-automatic triage NTS tool underestimated the urgency in 27% of patients with ACS/other LTEs. Overruling by triage nurses improved safety, but still 14% of men and women with ACS/other LTEs received too low urgency, while efficiency remained poor.Trial registration numberNTR7331.

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Ambulance dispatch versus general practitioner home visit for highly urgent out-of-hours primary care

Abstract: Research should be done on the process of triage and allocation of care to optimize labelling complaints with the appropriate urgency and to deploy the appropriate healthcare provider, especially for patients with chest pain.

Cited by 18 publications

References 22 publications

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

Co-location of Out of Hours Primary Care and Emergency Department in Belgium: Patients’ and Physicians’ View

The implementation of the nationwide out of hours phone number 1733. Analysis of efficiency and safety.

Accuracy of telephone triage in primary care patients with chest discomfort: a cross-sectional study

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