Walk-ins seeking treatment at an emergency department or general practitioner out-of-hours service: a cross-sectional comparison

Abstract

BackgroundEmergency Departments (ED) in Switzerland are faced with increasing numbers of patients seeking non-urgent treatment. The high rate of walks-ins with conditions that may be treated in primary care has led to suggestions that those patients would best cared for in a community setting rather than in a hospital. Efficient reorganisation of emergency care tailored to patients needs requires information on the patient populations using the various emergency services currently available. The aim of this study is to evaluate the differences between the characteristics of walk-in patients seeking treatment at an ED and those of patients who use traditional out-of-hours GP (General Practitioner) services provided by a GP-Cooperative (GP-C).MethodsIn 2007 and 2009 data was collected covering all consecutive patient-doctor encounters at the ED of a hospital and all those occurring as a result of contacting a GP-C over two evaluation periods of one month each. Comparison was made between a GP-C and the ED of the Waid City Hospital in Zurich. Patient characteristics, time and source of referral, diagnostic interventions and mode of discharge were evaluated. Medical problems were classified according to the International Classification of Primary Care (ICPC-2). Patient characteristics were compared using non-parametric tests and multiple logistic regression analysis was applied to investigate independent determinants for contacting a GP-C or an ED.ResultsOverall a total of 2974 patient encounters were recorded. 1901 encounters were walk-ins and underwent further analysis (ED 1133, GP-C 768). Patients consulting the GP-C were significantly older (58.9 vs. 43.8 years), more often female (63.5 vs. 46.9%) and presented with non-injury related medical problems (93 vs. 55.6%) in comparison with patients at the ED. Independent determining factors for ED consultation were injury, male gender and younger age. Walk-in distribution in both settings was equal over a period of 24 hours and most common during daytime hours (65%).Outpatient care was predominant in both settings but significantly more so at the GP-C (79.9 vs. 85.7%).ConclusionsWe observed substantial differences between the two emergency settings in a non gate-keeping health care system. Knowledge of the distribution of diagnoses, their therapy, of diagnostic measures and of the factors which determine the patients' choice of the ED or the GP-C is essential for the efficient allocation of resources and the reduction of costs.

Satisfaction of health professionals after implementation of a primary care hospital emergency centre in Switzerland: A prospective before–after study

“…However, it should be considered that the need for home visits in out-of-hours services in Switzerland still exists. Other publications from this large before-after study clearly showed the interdependency and need of both service options due to divergent patient demands and health problems in out-of-hours settings (Chmiel et al, 2011;Huber et al, 2011).…”

“…costs of care, reimbursement from insurers) and (iii) satisfaction of patients, GPs, ED staff and HGPs. Most of the results of i-iii have been published elsewhere (Chmiel et al, 2011;Eichler et al, 2010;Eichler et al, 2014;Huber et al, 2011;Wang et al, 2014), but not yet the job satisfaction of the involved health professionals as a result of implementing the new service model.…”

GP cooperative and emergency department: an exploration of patient flows

“…Recently, there is a trend towards physical co-location of primary care and EDs to provide out-of-hours care [2][3][4][5].…”

Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study

“…This measurement before intervention showed 54% self-referred patients (79% of them treated by ambulatory care), long waiting times and substantial treatment costs among outpatients treated with specialised emergency services. 10 The hospital owner decided for an organisational intervention according to the Cochrane Effective Practice and Organisation of Care (EPOC)-Group. 13 The change strategy focused on structure of care (redesign of the patient flow process), as well as on provider oriented issues (building of a new clinical multidisciplinary team; formal integration of services; improvement of staff satisfaction).…”