Safety and efficiency of a redirection procedure toward an out of hours general practice before admission to an emergency department, an observational study

Abstract

BackgroundPrimary care patients are often cited as a cause of Emergency Department overcrowding (ED). The aim of this study was to evaluate a physician led redirection procedure of selected patients towards an out of hours general practice (OHGP) in an Emergency Department with 55,000 admissions per year.MethodsObservational monocentric study over a period of 2 months. Every patient redirected to the OHGP was included and subsequently contacted by telephone to answer a standardized questionnaire, in order to measure:Redirection rate over the entire period and during weekdays or weekends/holidayRate of redirected patients who went to the OHGPRate of redirected patients who consulted in an ED in the next 72 h for the same reasonRedirected patients’ satisfaction rateResultsDuring the study period 9551 patients presented to the ED, of which 288 were redirected towards the OHGP (3%). The redirection rate was 1.9% during weekdays and 5.7% during weekends/holiday (p < 0.001). Of the redirected patients, 77% answered the telephone interview.Ninety percent of these patients consulted the OHGP. The main reasons for not consulting were: unduly long wait, opening hours not suitable, too costly. The rate of redirected patients who consulted in an ED in the following 72 h for the same reason was 4.1%. The satisfaction rate was 79.6% among interviewed patients.ConclusionsA physician led procedure to redirect selected patients from the ED towards an OHGP results in a low redirection rate, unlikely to have a significant effect on ED patient flow. However, the procedure is safe and well accepted by a majority of patients.

An integrative review of adult patient-reported reasons for non-urgent use of the emergency department

“…Thus, a multi-pronged approach may be required to limit excessive non-urgent visits. For example, simply redirecting non-urgent patients to other settings has been shown not to be wholly effective [ 108 ]. Instead, ensuring health care providers (at both PCP clinics and ED) understand how and why patients make decisions may help to provide insight and direct patient education.…”

CJEMDebate Series: #EDRedirection – Sending low-acuity patients away from the emergency department – An imperative for appropriateness and integration

“…As many as 50 to 88% of low-acuity ED patients initially seek but unsuccessfully access primary care 4 or would prefer a primary care appointment over an ED visit for their nonurgent needs. 5 Moreover, when redirected to alternative settings, ED patients report very high satisfaction rates (> 80%) with their care. 5 Furthermore, an extensive redirection protocol implemented in Montréal in 2015 has been used to date on more than 52,000 patients from five different hospitals.…”

“…5 Moreover, when redirected to alternative settings, ED patients report very high satisfaction rates (> 80%) with their care. 5 Furthermore, an extensive redirection protocol implemented in Montréal in 2015 has been used to date on more than 52,000 patients from five different hospitals. Research on this protocol showed that eligible patients who accepted to be redirected away from the ED were four times more likely to be satisfied with their care than those choosing to stay in the ED after being offered but declining a 24-to 48-hour appointment at a walk-in clinic.…”

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Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department

“…Other strategies are used to identify redirection eligible patients such as implementing a systematic emergency physician assessment at the ED entrance or selecting them based on their chief complaint. Both strategies have important limits and are not reproducible nor can they be extrapolated to other settings [21,39,40]. A proper identification strategy should take into account various patient information, medical history, vital risk assessment, chief complaint, but also its environment and comprehensiveness of the redirection process.…”