Role of out of hours primary care service in limiting inappropriate access to emergency department

Abstract

Out of hours (OOH) doctors can have an important gate-keeping role over the access to the emergency department (ED), but the outcome and the quality of their ED referrals have been poorly studied. We aimed to investigate the outcome of patients referred to ED from OOH service and the determinants of admission or short-stay dispositions. We collected retrospectively data about referrals to ED from a local OOH service in the north-east of Italy using the OOH paper register and the ED electronic database, over the period of 01/10/2012 to 31/03/2013. Out of 5217 patients accessing the OOH service, 408 referrals were included in our analysis. 45.3% (185) of the referrals were admitted to hospital or the short-stay unit, 26 patients (=6.4%) were discharged as non-urgent outgoing codes after no specialist consultation or test, suggesting inappropriate referrals, and, of the remaining 197 (=48%), only 10 did not undergo any investigation or consultation. Significant determinants of admission were: age ≥65 years (OR = 2.619; 95% CI 1.528-4.491, p < 0.0001), domiciliary examination (OR = 2.168; 95% CI 1.353-3.476, p = 0.001), nursing home/palliative care setting (OR = 2.563; 95% CI 1.228-5.351, p = 0.012) and OOH triage code, ranging from an OR of 7.47 (95% CI 3.028-18.433) for minor urgencies to an OR of 26.835 (95% CI 6.761-106.508, p < 0.0001) for emergencies, in comparison to no urgent codes. OOH service seems to play an effective gate-keeping role limiting ED access. Determinants of admission to hospital suggest some simple interventions that could improve the adequacy of ED referral from OOH service.

Home Health Care Nursing Impacts on Emergency Department Utilization

“…Using validated instruments such as the in-terRAI HC (interRAI, 2020; www.interrai.org) and Hospital ED Risk Index or others provide objective measures that reflect risks for ED utilization and hospitalization according to contributing factors and determinants (Rönneikkö et al, 2017). These findings are also supported by other studies that additionally take into account demographics such as age and gender and contextual factors such as hour of the phone call, distance to nearest ED/resource, among other clinical variables that influence decisions (Posocco et al, 2018;Rönneikkö et al, 2017;Takahashi, Heinen, Sangaralingham, Shah, & Naessens, 2016).…”

Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis

“…In many studies, it was found that reasonable access to primary care providers such as GPs and continuity of care measured by seeing the same family doctor were essential factors in reducing non-emergent ED visits [30,31]. In the current health system, while it may seem that patients being unable to access immediate health service leads them to prefer EDs [29], many studies have shown that the level of service, working hours, and increased professionalism do not decrease the use of EDs [8,24,[32][33][34].…”

Effect of Access to After-Hours Primary Care on the Association Between Home Nursing Visits and Same-Day Emergency Department Use

“…Some cross-sectional and survey studies have suggested that an increase in access to primary after-hours care could reduce emergency department visits 4,[17][18][19] while other cohort studies and systematic reviews of interventions found no reduction. 5,6 Our study is novel in that it tests the effectiveness of after-hours primary care in terms of its ability to reduce the risk of an emergency department visit following an event known to increase risk and does so within a selfmatched study design.…”

“…In theory, greater access to after-hours primary care can divert less-urgent visits away from the emergency department, which is crowded, disrupts continuity of care, and is typically not designed to meet the care needs of complex, older adults. 1,2 The existing literature testing this hypothesis, however, has produced conflicting results, with some studies showing that increased access to after-hours primary care is associated with fewer emergency department visits 3,4 and others finding no difference. 5,6 Older adults receiving home care services are a growing, frail population with particularly high rates of emergency department use.…”