Streaming A&amp;E patients to walk-in centre services

Bickerton, Jane; Dewan,; Allan, Teresa

doi:10.7748/en2005.06.13.3.20.c1047

Cited by 4 publications

(8 citation statements)

References 5 publications

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“…The results of the retrospective analysis support the earlier study (Bickerton et al ., 2005) where no statistically significant agreement was found between clinicians on which was the appropriate service for the patient. In this study, there was total agreement on the service required in 30.5% of cases (178), mixed agreement by two assessors out of three for 59.2% of cases (346) and total disagreement for 10.3% of cases (60).…”

Section: Resultsmentioning

confidence: 96%

“…A sample of 200 patients from each of the three participating sites (600 total) was required to detect an average kappa level of agreement of 0.42 on the basis of the pilot study (Bickerton et al, 2005) and the findings from a study of previous professional comparisons (O'Cathain et al, 2003) with 90% power and 5% significance. This assumes that there is an agreed proportion of necessary attendances triaged to ED by each person of 62% (on the basis of average sensitivity; O'Cathain et al, 2003).…”

Section: Samplementioning

confidence: 99%

“…The study reported here builds on a pilot study (Bickerton et al, 2005) that aimed to see whether National Health Service (NHS) staff, using only the information available at initial presentation, could identify specific groups of patients who received treatment in ED, but who might have been more appropriately directed to a WiC. The pilot study found that experienced health-care professionals had difficulty in classifying patients on the basis of the information available at first presentation.…”

Section: Introductionmentioning

confidence: 99%

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Streaming primary urgent care: a prospective approach

Bickerton

Davies

et al. 2011

Prim Health Care Res Dev

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This is the unspecified version of the paper.This version of the publication may differ from the final published version. The health user survey identified younger rather than older users (mean age of 35.6 years -SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. Conclusion: A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery. Permanent repository link

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Section: Resultsmentioning

confidence: 96%

Section: Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Streaming primary urgent care: a prospective approach

Bickerton

Davies

et al. 2011

Prim Health Care Res Dev

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“…5,14,15 Attempts to provide a solution have included public education, provision of PC within EDs, co-location of PC centres and redirection by nurse triage. 4,5,[14][15][16][17] Recent studies suggest that around 16% of ED attendances could be seen in PC although higher figures have been reported. [3][4][5] Reducing this number would reduce ED overcrowding.…”

Section: Discussionmentioning

confidence: 99%

“…5,14,15 Attempts to provide a solution have included public education, provision of PC within EDs, co-location of PC centres and redirection by nurse triage. 4,5,14–17…”

Section: Discussionmentioning

confidence: 99%

Emergency Department redirection to primary care: a prospective evaluation of practice

et al. 2017

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The impact of general practitioners working in or alongside emergency departments: a rapid realist review

et al. 2019

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ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

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Streaming A&E patients to walk-in centre services

Cited by 4 publications

References 5 publications

Streaming primary urgent care: a prospective approach

Streaming primary urgent care: a prospective approach

Emergency Department redirection to primary care: a prospective evaluation of practice

The impact of general practitioners working in or alongside emergency departments: a rapid realist review

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