Abstract
Aim: We describe activity, outcomes and benefits after streaming low urgency attenders to General practice services at Door of Accident and Emergency departments (GDAE).
Background: Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics and potential benefits when primary care is co-located with A&E departments.
Methods: As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four hour key performance indicator was descriptively compared for co-located and similar emergency departments.
Findings: Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care relatively shortened at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection or feeling generally unwell each comprised > 10% of primary reasons for attendance. At JPUH 4.3% and at QEH 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.
Background: Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics and potential benefits when primary care is co-located with A&E departments.
Methods: As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four hour key performance indicator was descriptively compared for co-located and similar emergency departments.
Findings: Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care relatively shortened at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection or feeling generally unwell each comprised > 10% of primary reasons for attendance. At JPUH 4.3% and at QEH 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.
| Original language | English |
|---|---|
| Article number | e5 |
| Journal | Primary Health Care Research & Development |
| Volume | 26 |
| Early online date | 10 Jan 2025 |
| DOIs | |
| Publication status | Published - 2025 |
Keywords
- Emergency department
- low acuity presentations
- wait times
- Service evaluation