Self-referrals in a Dutch Emergency Department: how appropriate are they?

Kraaijvanger, Nicole; Rijpsma, Douwe; Leeuwen, Henk van; Dijk, N. van; Edwards, Michael J.

doi:10.1097/mej.0000000000000216

Cited by 21 publications

(20 citation statements)

References 16 publications

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“…This function aims to ensure that patients in need of more specialized care can access secondary healthcare facilities, but also that patients are guided to primary care, when this is sufficient. Some patients still by-pass this setup, a well-known issue in countries with similar healthcare setups [ 16 , 17 ]. Considering the differences in setup, we primarily compared our study to studies from countries with similar healthcare organization e.g.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and mortality of emergency department patients in the North Denmark region

Søvsø

Hermansen

Færk

et al. 2018

BMC Health Serv Res

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BackgroundEmergency departments handle a large proportion of acute patients. In 2007, it was recommended centralizing the Danish healthcare system and establishing emergency departments as the main common entrance for emergency patients. Since this reorganization, few studies describing the emergency patient population in this new setting have been carried out and none describing diagnoses and mortality. Hence, we aimed to investigate diagnoses and 1- and 30-day mortality of patients in the emergency departments in the North Denmark Region during 2014–2016.MethodsPopulation-based historic cohort study in the North Denmark Region (580,000 inhabitants) of patients with contact to emergency departments during 2014–2016. The study included patients who were referred by general practitioners (daytime and out-of-hours), by emergency medical services or who were self-referred.Primary diagnoses (ICD-10) were retrieved from the regional Patient Administrative System. For non-specific diagnoses (ICD-10 chapter ‘Symptoms and signs’ and ‘Other factors’), we searched the same hospital stay for a specific diagnosis and used this, if one was given. We performed descriptive analysis reporting distribution and frequency of diagnoses. Moreover, 1- and 30-day mortality rate estimates were performed using the Kaplan-Meier estimator.ResultsWe included 290,590 patient contacts corresponding to 166 ED visits per 1000 inhabitants per year. The three most frequent ICD-10 chapters used were ‘Injuries and poisoning’ (38.3% n = 111,274), ‘Symptoms and signs’ (16.1% n = 46,852) and ‘Other factors’ (14.52% n = 42,195). Mortality at day 30 (95% confidence intervals) for these chapters were 0.86% (0.81–0.92), 3.95% (3.78–4.13) and 2.84% (2.69–3.00), respectively.The highest 30-day mortality were within chapters ‘Neoplasms’ (14.22% (12.07–16.72)), ‘Endocrine diseases’ (8.95% (8.21–9.75)) and ‘Respiratory diseases’ (8.44% (8.02–8.88)).ConclusionsPatients in contact with the emergency department receive a wide range of diagnoses within all chapters of ICD-10, and one third of the diagnoses given are non-specific. Within the non-specific chapters, we found a 30-day mortality, surpassing several of the more organ specific ICD-10 chapters.Trial registrationObservational study - no trial registration was performed.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3361-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and mortality of emergency department patients in the North Denmark region

Søvsø

Hermansen

Færk

et al. 2018

BMC Health Serv Res

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“…This is consistent with our findings in a previous study, indicating that 48% to 59% of ED visits by self-referred patients are appropriate. 2 This means that a large number of self-referred patients are in need of secondary care. This suggests that refusing self-referred patients in the ED might lead to missed diagnoses or even an increase in adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Also, people encounter difficulties in gaining an appointment with a GP or have been advised by others to directly attend to an ED . Self‐referred patients in urgent triage categories visit the ED appropriately more often . However, patients may view nonurgent symptoms as urgent, leading to inappropriate self‐referral and unnecessary costs.…”

Section: Introductionmentioning

confidence: 99%

“…This number ranges from 3% to 76% for individual EDs . In 41% to 52%, health issues of self‐referred patients can be taken care of in a primary care facility at lower costs . When treating minor illnesses at a hospital ED, there is a risk of overuse of diagnostic modalities and overtreatment.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12][13][14] Self-referred patients in urgent triage categories visit the ED appropriately more often. 2 However, patients may view nonurgent symptoms as urgent, leading to inappropriate self-referral and unnecessary costs.…”

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confidence: 99%

See 2 more Smart Citations

Why patients self‐refer to the Emergency Department: A qualitative interview study

Kraaijvanger

Rijpsma

Willink

et al. 2016

Evaluation Clinical Practice

Self Cite

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Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial

Morreel¹,

Homburg²,

Philips³

et al. 2022

Health Policy

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Self-referrals in a Dutch Emergency Department: how appropriate are they?

Abstract: The percentage of appropriate ED visits by self-referred patients in the Netherlands ranges from 48.1 to 58.8%, as determined using two different methods.

Cited by 21 publications

References 16 publications

Diagnosis and mortality of emergency department patients in the North Denmark region

Diagnosis and mortality of emergency department patients in the North Denmark region

Why patients self‐refer to the Emergency Department: A qualitative interview study

Cost effects of nurse led triage at an emergency department with the advice to consult the adjacent general practice cooperative for low-risk patients, a cluster randomised trial

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