Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay

Rutten, Mcm Marcel; Giesen, Paul; Assendelft, W. J. J.; Westert, Gert P.; Smits, Marleen

doi:10.1080/13814788.2021.1959911

Cited by 4 publications

(15 citation statements)

References 20 publications

(35 reference statements)

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“…An additional advantage of co‐location is the possibility of direct access to hospital diagnostics, such as radiology facilities. Previous Dutch studies assessed the effect of GPs' out‐of‐hours access to radiology facilities and found a substantial decrease in ED trauma patient referrals and increased patient satisfaction levels 5,6,16 . Consistent with those studies, the use of diagnostics by GPs in our study seemed adequate.…”

Section: Discussionsupporting

confidence: 89%

Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Kusters

Peters

Osch

et al. 2022

Evaluation Clinical Practice

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Rationale, Aims and Objectives Low‐urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways. Methods Single‐centre retrospective observational study of trauma patients referred to the ED by the radiology department during office hours (January 2017–December 2017). Data were obtained from patient records. Descriptive statistics were used to analyse the extracted data. Results A total of 662 patients were included. The median age was 42 years (range: 1–100, interquartile range (IQR): 15–63) and patients presented to the ED with a median delay of 1 day (range: 0–112 days, IQR: 0–5). Most patients were referred for injuries involving the upper extremities (61.5%) and lower extremities (30%). A total of 48 additional diagnoses were made in the ED. The majority of injuries was classified as ‘minor’ (29.5%) or ‘moderate’ (68.3%) on the Abbreviated Injury Scale (AIS). The median length of stay in the ED was 65 min (range: 7–297 min, IQR: 43–102). Conclusion Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.

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Section: Discussionsupporting

confidence: 89%

Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Kusters

Peters

Osch

et al. 2022

Evaluation Clinical Practice

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“…Other studies that specifically deal with treatment of fractures, both in hospitals and the primary health care service, find similar figures of patient satisfaction with diagnosing and treatment of fractures. [ 25 , 26 ]…”

Section: Discussionmentioning

confidence: 99%

“…However, also elsewhere in Norway and Europe x-ray examinations and fracture treatment are carried out and X-rays are sent to the nearest hospital for assessment and can be discussed with a radiologist and orthopedist. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes after initial conservative fracture treatment in primary healthcare – a survey study

et al. 2022

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Background Primary healthcare in Norway has first-line responsibility for medical emergencies, including traumas and fractures. Normally, patients with suspected fractures are referred to specialist care. However, some municipalities have X-ray facilities and handle minor fractures locally. We investigated patient-reported outcome measures after initial treatment of radiologically diagnosed fractures of the wrist, collarbone, and ankle at a primary healthcare centre in a rural municipality with a large ski resort. The patients’ general satisfaction with the treatment was also investigated. Methods Validated questionnaires were sent to patients with fractures of the wrist or collarbone (Quick DASH—Disability of Arm, Shoulder and Hand) or the ankle (FAOS -The Foot and Ankle Outcome Score). Patients with wrist and collarbone fractures also answered the Quality-of-life questions that are a subscale of the FAOS questionnaire for ankle fractures. Patient satisfaction was measured for all fracture groups. The Quick DASH scale ranges from 0 (no disability at all) to 100 (great disability), while for FAOS a score of 100 indicates no symptoms and 0 indicates extreme disabilities. Results A total of 148 of 238 patients answered the questionnaire (62% response rate). Patients with distal radius fractures had a mean Quick DASH score of 5.1 (median 0, range 0–77), and scores were significantly lower for males (p = 0.013) and increased with age (p = 0.024). Patients with collarbone fractures had a mean Quick DASH score of 2.1 (median 0, range 0–32) with no significant age or gender differences. Patients with ankle fractures had the following mean subscale-scores: Pain, 93.8; Symptoms, 71.4; Activities of daily living, 97.4; Sport, 90.0; and Quality of life, 92.1. The scores did not differ significantly by specialization of the physician. A total of 88% of the patients were highly or very highly satisfied with the handling of their fracture. Conclusions The patients reported low rates of functional disability and high rates of satisfaction after initial radiological diagnosis and treatment of their fracture at the primary healthcare centre. Specialisation of the treating physician was not associated with the outcome in any of the fracture types.

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“…The 23 studies included in this review used various study types. There were six cohort studies [21][22][23][24][25][26], four randomised controlled trials [27][28][29][30], four observational studies [13,[31][32][33], three cross-sectional studies [34][35][36], three questionnaire studies [6,37,38], one retrospective analysis [39], one feasibility study [40], and one systematic review [3].…”

Section: Methodsmentioning

confidence: 99%

“…Seven studies were based in Denmark [21, 24-25, 28-30, 40], seven in the UK [3,13,23,27,36,38,39], six in the Netherlands [22,26,[31][32][33]35], two in Ireland [6,37], and one in Italy [34].…”

Section: Methodsmentioning

confidence: 99%

Impact of enhancing GP access to diagnostic imaging: A scoping review

Phelan

Broughan²,

McCombe³

et al. 2023

PLoS ONE

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Background Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. Methods A search was conducted of ‘PubMed’, ‘Cochrane Library’, ‘Embase’ and ‘Google Scholar’ for papers published between 2012–2022 using Arksey and O’Malley’s scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). Results Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. Conclusion Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.

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Effects of access to radiology in out-of-hours primary care on patient satisfaction and length of stay

Cited by 4 publications

References 20 publications

Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Patient-reported outcomes after initial conservative fracture treatment in primary healthcare – a survey study

Impact of enhancing GP access to diagnostic imaging: A scoping review

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