The effect of a general practice after‐hours clinic on emergency department presentations: a regression time series analysis

Abstract

Objective: To assess the impact of the opening of an after‐hours general practice clinic on the number of daily low‐urgency presentations to the nearby emergency department. Design, participants and setting: Retrospective time series analysis of emergency presentation data, from the New South Wales Health Emergency Department Information System, for all patients presenting to the emergency department of Wagga Wagga Base Hospital between January 1998 and October 2008. Main outcome measures: Daily emergency department presentations, before and after the March 2003 opening of the after‐hours clinic, of patients triaged as Australasian Triage Scale (ATS) category 4 or 5 (at any time of day, and during the hours of operation of the clinic), and of patients triaged as ATS category 1, 2 or 3 (at any time of day). Results: After adjusting for long‐term trends and weekly and annual cycles, the opening of the after‐hours clinic was associated with a daily reduction of 7.04 patients (95% CI, 5.39–8.70) in emergency department presentations with an ATS category of 4 or 5. This represented an 8.2% reduction in total presentations (95% CI, 6.2%–10.2%). Presentations of ATS category 1, 2 or 3 patients rose by 1.36 patients a day (95% CI, 0.36–2.35), representing 1.6% of total presentations (95% CI, 0.4%–2.7%). The impact of the after‐hours clinic was best modelled by a gradual permanent change. Conclusion: An after‐hours general practice clinic was associated with a reduction in low‐urgency presentations to the emergency department in Wagga Wagga.

The Manchester triage system: improvements for paediatric emergency care

“…This proportion is comparable with referral rates in other settings where primary care physicians are available, with referral rates ranging from 30% to 80% (European countries,35–38 Australia,39 40 the USA41 42 and Canada43 44). Therefore, we think that are results are generalisable to these other populations as well.…”

Public use and perceptions of emergency departments: A population survey

“…New approaches are needed as some of the current policy responses (e.g. telephone call centres, collocated or after‐hours GP services) have proven to be either ineffective or only marginally effective . These policies have been driven by targets rather than evidence (e.g.…”

“…PUBLIC USE AND PERCEPTIONS OF EMERGENCY DEPARTMENTS have proven to be either ineffective or only marginally effective. 19,20,28,29 These policies have been driven by targets rather than evidence (e.g. NEAT), 30 or have been based on prejudicial attitudes towards the patients (e.g.…”

Trends in New South Wales infant hospital readmission rates in the first year of life: a population‐based study

“…Although we do not have access to emergency department (ED) data, there were a number of changes to ED policy and practice in NSW over this period that may have reduced hospital admissions from the ED. These included introducing additional senior ED nurses who had a wider scope of practice 17 and opening after‐hours general practice clinics at or near EDs, 18 with a recent study showing that such clinics were associated with a reduction in low‐urgency presentations to the ED 19 …”