Can a partnership between general practitioners and ambulance services reduce conveyance to emergency care?

Abstract

BackgroundEmergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department(ED) .MethodsThe service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria. GPs supported the assessment of such patients either at scene or by telephone. Routine data were collected from October 2012 to November 2013, from the ambulance service computer-aided dispatch system. Logistic regression models were used to determine the likelihood for patients being transported to ED.ResultsOf 23 395 emergency contacts during the evaluation period, 1903 (8.1 %) patients were triaged to GP supported assessment. Mean age (SD) was 61.8 (27.9) years; 42.9 % were aged 75 years and over. 1221 (64.2%) had face-to-face GP assessment and 682 (35.8%) via telephone. 1500 (78%) of those who received GP support were not transported to hospital. After controlling for confounders, those aged greater than 75 years (OR 0.67; 95% CI 0.52 to 0.86), and females (OR 0.64; 95% CI 0.51 to 0.82) were less likely to be transported, while those who received GP telephone input rather than face-to-face assessment were more likely to be transferred to an ED (OR 2.14; 95% CI 1.69 to 2.72).ConclusionSupport of the paramedic service by GPs enabled patients to avoid transfer to an ED, potentially avoiding subsequent hospital admission, reducing costs and improving quality of care for patients that are not in need of hospital services. However, use of services in the days following the call was not assessed, and hence the overall impact and safety requires further evaluation.

General practitioner‐type patients in emergency departments in metro North Brisbane, Queensland: A multisite study

“…Furthermore, the ED is an attractive source of medical care because of perceived convenience and access to specialised care and ancillary investigations (pathology and radiology) . Strategies to reduce demand may include primary and secondary prevention, pre‐hospital diversion and telephone advice . Reducing ED presentations may reduce hospital costs …”

Effect of requiring a general practitioner at scenes of serious injury: A systematic review

“…The search for primary studies identified 4653 references. Of those, 47 were potentially relevant (Figure ), and we examined the full text . However, none fulfilled our inclusion criteria.…”

Self reported involvement in emergency medicine among GPs in Norway

“…In 2013, R⊘rtveit found that the EMCC has problems with over and under triage, and having a GP on the scene was suggested as a solution to this challenge [ 16 ]. A recent study from England also found that involving GPs improved prehospital treatment by providing better treatment and reducing the number of patients who were admitted to hospital [ 17 ]. Despite reporting having a large role in local emergency medicine, the GPs in our survey reported that they only took part in a select number of ambulance call outs.…”