Hospital‐integrated general practice: a promising way to manage walk‐in patients in emergency departments

Wang, Mathyas; Wild, Stefanie; Hilfiker, Gabriela; Chmiel, Corinne; Sidler, Patrick; Eichler, Klaus; Rosemann, Thomas; Senn, Oliver

doi:10.1111/jep.12074

Cited by 34 publications

(41 citation statements)

References 29 publications

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“…Nine papers were included in the review: 10,143,[197][198][199][200][201][202][203] two systematic reviews, 10,197 which included 28 individual papers, and seven additional papers. 143,[198][199][200][201][202][203] The results of the review sifting process are given in Figure 5.…”

Section: Resultsmentioning

confidence: 99%

“…A study of a primary care patient navigation service significantly reduced the likelihood of ED readmission for less-frequent primary care-related ED users 200 and produced cost savings, while a hospital-integrated general practice service was shown to have potential to significantly reduce the time from admission to discharge and resource use as primary care doctors used fewer diagnostics than ED physicians. 203 A broader study examined longitudinal trends in ED attendances over 3 years after introducing integrated OOH GP co-operatives. 202 The findings were that, overall, ED attendances, and in particular self-referrals, decreased but referrals from GPs to EDs increased, as did ED admissions.…”

Section: Summary Of Findingsmentioning

confidence: 99%

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What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.

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Section: Resultsmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Turner

Coster

Chambers

et al. 2015

Health Serv Deliv Res

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“…costs of care, reimbursement from insurers) and (iii) satisfaction of patients, GPs, ED staff and HGPs. Most of the results of i-iii have been published elsewhere (Chmiel et al, 2011;Eichler et al, 2010;Eichler et al, 2014;Huber et al, 2011;Wang et al, 2014), but not yet the job satisfaction of the involved health professionals as a result of implementing the new service model.…”

Section: Methodsmentioning

confidence: 99%

“…Index (ESI) with a score ranging from 1 "life threatening" to 5 "least severe" (Elshove-Bolk et al, 2007). Thereafter, patients arriving at hospital due to illness or injury were navigated either to the hospital-associated primary care centre with HGPs as a "fast track" (Guo and Harstall, 2006) Detailed information about the intervention is published elsewhere Wang et al, 2014). Subjects and data collection Development of questionnaires.…”

Section: Settingmentioning

confidence: 99%

Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before–after study

Hess

Sidler

Chmiel

et al. 2015

International Emergency Nursing

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BACKGROUND AND AIM: The increasing number of patients requiring emergency care is a challenge and leads to decreased satisfaction of health professionals at emergency departments (EDs). Thus, a Swiss hospital implemented a hospital-associated primary care centre at the ED. The study aim was to investigate changes in job satisfaction of ED staff before and after the implementation of this new service model and to measure hospital GPs' (HGPs) satisfaction at the hospital-associated primary care centre. METHOD: This study was embedded in a large prospective before-after study over two years. We examined changes in job satisfaction with a questionnaire followed by selected interviews approaching all of the involved 25 ED staff members and 38 HGPs. RESULTS: The new emergency care model increased job satisfaction of ED staff and HGPs in all measured dimensions. The overall job satisfaction of ED employees improved from 76.5 to 83.9 points (visual analogue scale 0-100; difference 7.4 points [95% CI: 1.3 to 13.5, p = 0.02]). 86% of 29 HGPs preferred to provide their out-of-hours service at the new hospital-associated primary care centre. CONCLUSIONS: The hospital-associated primary care centre is a promising option to improve job satisfaction of different health professionals in emergency care.

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“…Point of care diagnoses are based on a team of GPs and facilities are located within hospital EDs (Wang et al, 2013). The new emergency care model turned out to be considerably more efficient than the traditional one, resulting in reduced time from admission to discharge and a decrease in ED resource utilisation.…”

mentioning

confidence: 99%

Emergency Care Services

Berchet

2015

OECD Health Working Papers

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Hospital‐integrated general practice: a promising way to manage walk‐in patients in emergency departments

Cited by 34 publications

References 29 publications

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before–after study

Emergency Care Services

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