Admissions to the medical department – who admits and why

Grøndahl, Jan Robert; Fossdal, Øystein; Hauge-Iversen, Torgeir; Husebye, Einar; Rosvold, Elin Olaug; Kongshavn, Trygve

doi:10.4045/tidsskr.17.0516

Cited by 5 publications

(6 citation statements)

References 11 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although Norway has a gatekeeper-based healthcare system, we found that only 56% of the emergency-admitted patients came through the primary healthcare gatekeeping system. This is in line with the findings of Grondal et al from a smaller study at a medical department in Norway, where GPs and OOH doctors referred 26 and 31%, respectively [17]. A reasonable level of gatekeeping for emergency admissions is not possible to determine.…”

Section: Discussionsupporting

confidence: 75%

“…This makes the Norwegian healthcare system well suited to study the impact of strict gatekeeping on emergency admissions. A Norwegian study from a single hospital indicated that patients admitted for emergencies to a medical department often did not have any contact with GPs or out-of-hours (OOH) doctors prior to the admission [17]. However, a nationwide analysis of the prehospital paths for emergency hospital admissions in a public healthcare system where GPs and OOH doctors have a distinct gatekeeper function, like Norway, has not been conducted.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

Blinkenberg

Pahlavanyali

Hetlevik

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

Background Primary care doctors have a gatekeeper function in many healthcare systems, and strategies to reduce emergency hospital admissions often focus on general practitioners’ (GPs’) and out-of-hours (OOH) doctors’ role. The aim of the present study was to investigate these doctors’ role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function. Methods A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians’ claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24 h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors. Results In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs’ referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46–49% were referred by GPs, for acute appendicitis and mental/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions. Conclusions GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs’ and OOH doctors’ gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs’ and OOH doctors’ gatekeeper roles, even in a strict gatekeeping system.

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

Blinkenberg

Pahlavanyali

Hetlevik

et al. 2019

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…A Danish study found that more home visits reduced hospitalization length for cancer patients ( 16 ). Interestingly, GPs are only involved in 26–46% of hospitalizations of patients ( 34 , 35 ). The rest are initiated by OOH services, patients and/or families, outpatient clinics or agreement directly with hospital wards ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

et al. 2020

View full text Add to dashboard Cite

Background General practitioners (GPs) may play an important role in providing end-of-life care to community-dwelling people. Objective To investigate patients' contacts with GPs, GPs' interdisciplinary collaboration, out-of-hours services and hospitalizations in the last 13 weeks of life and associations with dying at home. Second, investigate whether GP contacts were associated with fewer out-of-hours contacts or days hospitalized. Methods Individually linked data from the Norwegian Cause of Death Registry, Norwegian Patient Registry, Statistics Norway and Control and Payment of Reimbursement to Health Service Providers database for all 80 813 deceased people in Norway within 2012–13. Outcomes were analyzed with logistic regression and negative binomial multilevel mixed-effect models. Results Overall, 1% of people received GP home visits in Week 13 and 4.6% in the last week before death. During the last 4 weeks of life, 9.2% received one or more GP home visits. Altogether, 6.6% received one or more home visits when the GP had one or more interdisciplinary collaborations during the last 4 weeks, of which <3% died at home. GP office consultations decreased towards the end of life. The likelihood of home death versus another location increased in relation to GP home visits [one home visit odds ratio (OR) 1.92, confidence interval (CI) 1.71–2.15; two or more OR 3.49, CI 3.08–3.96] and GP interdisciplinary collaboration (one contact OR 1.76, CI 1.59–1.96; two or more OR 2.52, CI 2.32–2.74). Conclusions GPs play a role in enabling people to die at home by performing home visits and collaborating with other health care personnel. Only a minority received such services in Norway.

show abstract

“…They should monitor these patients closely to capture deterioration of the clinical condition. The low sensitivity of a single triage measure to predict care level has been reported elsewhere [20,21]. However, repeated TEWS seems to be a useful way of discovering lack of improvement.…”

Section: Comparison With Other Studiesmentioning

confidence: 95%

Associations between characteristics of the patients at municipal acute bed unit admission and further transfer to hospital: a prospective observational study

Hernes

Baste

Krokmyrdal

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background As an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level. Patient selection is challenging, and some patients need transfer from MAUs to hospitals. The aim of this study was to examine associations between characteristics of the patient at admission to MAU and further transfer to hospital. Methods In a prospective observational study on all admissions to a large MAU, March 2016–August 2017, information was obtained on patient age, gender, comorbidities, drug use, reason for stay and Triage Early Warning Score (TEWS) on admission and at discharge, and length of stay. Comparison between admissions resulting in discharge to hospital, nursing home or own home were performed with chi-square and ANOVA tests. Estimated relative risks (RR) with 95% confidence interval for transfer to hospital versus being retained at primary care level was estimated for age, gender, comorbidity and TEWS in generalized linear models, crude and adjusted. Results Two thousand seven hundred forty-four admissions were included. Mean age of the patients was 69.5 years (SD 21.9), 65.2% were women. In 646 admissions (23.6%), the patients were transferred to hospital. Male gender and TEWS > 2 were associated with transfer to hospital. Most transfers to hospital occurred within 24 h, and these patients had unchanged or increasing TEWS during their stay at MAU. When transferred to hospital 41.5% of the patients had the same reason for stay as on MAU admission, 14.9% had another reason for stay, 25.2% had a medical condition outside the treatment scope of MAU, and 18.4% needed further diagnostic clarification in hospital. Conclusions Likelihood of transfer to hospital increased with male gender and higher TEWS on admission. Main reasons for transfer to hospital were lack of improvement and identification of clinical conditions that needed hospital care. TEWS > 2 at admission should make physicians alert to the need of close monitoring for lack of improvement.

show abstract

Admissions to the medical department – who admits and why

Cited by 5 publications

References 11 publications

General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

General practitioners' provision of end-of-life care and associations with dying at home: a registry-based longitudinal study

Associations between characteristics of the patients at municipal acute bed unit admission and further transfer to hospital: a prospective observational study

Contact Info

Product

Resources

About