Norwegian regular general practitioners' experiences with out-of-hours emergency situations and procedures

Zakariassen, Erik; Sandvik, Hogne; Hunskaar, Steinar

doi:10.1136/emj.2007.054338

Cited by 19 publications

(19 citation statements)

References 9 publications

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“…A paper from 2009 investigating emergency medicine in a rural community suggested mandatory training on a regular basis for GPs taking part in out-of-hours work, supporting the view of our informants [7]. The need for interdisciplinary training as described by the EMTs has also been found in previous studies [6],[15]. …”

Section: Discussionsupporting

confidence: 80%

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

Hjortdahl

Zakariassen

Wisborg

2014

Scand J Trauma Resusc Emerg Med

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BackgroundTogether with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting.MethodsWe conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation.ResultsThe EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis.ConclusionsEMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call.

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Section: Discussionsupporting

confidence: 80%

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

Hjortdahl

Zakariassen

Wisborg

2014

Scand J Trauma Resusc Emerg Med

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“…A study found geographical differences in the involvement of Norwegian doctors on-call in pre-hospital emergencies, but the study was limited to situations where the air ambulances were alerted as well [6]. Two studies have investigated rGPs'experiences with emergency situations, though not red responses in particular, through the EMCC system [7,8]. On a national basis the EMCCs in Norway alerted doctors on-call in about 50% of the red response cases [9].…”

Section: Introductionmentioning

confidence: 99%

Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

Zakariassen

Hunskaar

2010

BMC Emerg Med

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BackgroundPrimary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority), using three different emergency medical communication centres (EMCC) as catchment area for a prospective population-based study.MethodsIn the period from October to December 2007 three dispatch centres covering approximately 816 000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies.Results5 105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms) from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations.ConclusionDoctors on-call and GPs on daytime were involved in half of all red responses. There were large differences between the EMCCs in the frequency of doctors alerted. The inhabitants in the three EMMCs were thus offered different levels of professional competency in emergency situations outside hospitals.

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“…The general practitioners and urgent care centres have been assigned a key role as gatekeepers for the specialist health services including the EDs,15 and it is therefore not a surprise that a large portion of our patient population arrive from the urgent care centre. Surprisingly, around 15% of the assumed low acuity patients seen at the urgent care are transferred to the ED.…”

Section: Discussionmentioning

confidence: 99%

Patient visits to the emergency department at a Norwegian university hospital: variations in patient gender and age, timing of visits, and patient acuity

2012

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The increase in ED visits to the St. Olav's Hospital in recent years follows the same trend as in other countries. The authors see a slightly higher percentage of high level acuity patients compared with international studies due the general practitioner's intended 'gatekeeper' function. The authors also found a high total admission rate and a low ICU admission rate compared with other countries. These differences cannot be explained solely by differences in the healthcare system in Norway. The cultural and traditional organisation of the Norwegian Health Care System needs to change and this creates an excellent opportunity to improve the competence by establishing emergency medicine as a specialty in Norway.

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Norwegian regular general practitioners' experiences with out-of-hours emergency situations and procedures

Cited by 19 publications

References 9 publications

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

Patient visits to the emergency department at a Norwegian university hospital: variations in patient gender and age, timing of visits, and patient acuity

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