Feasibility and evaluation of an emergency department‐based general practitioner streaming and treatment service

Abstract

Rationale: Offering a primary care service that can provide good quality primary care at emergency departments may reduce pressure on usual emergency department (ED) services.Aims and Objectives: To evaluate the acceptability, satisfaction, and potential impacts of a co-located primary care service at an emergency department.Methods: This is a prospective feasibility study and service evaluation comprising a narrative summary of activity, satisfaction, well-being, and safety, and comparisons of wait times for ED services by patient category ('minor', 'majors', 'paediatric' or 'resus') before and during the service operation. Patients and staff were asked using semistructured interview topic guides about service perception, well-being, representation within 48 h, safety concerns, and/or satisfaction. Wait times for patient categories in usual ED care service were in secondary care electronic records. Pathway changes were captured under primary care electronic records.Results: Approximately 96% of general practitioner streaming and treatment (GPST) patients were seen within 1 h. There was a statistically significant reduction in ED patients with minor injuries or illnesses waiting >4 h for admission or discharge 'breaches' during the 3 months that GPST was operating compared with the previous 3 months (p ≤ 0.005). Wait times for other ED services did not significantly improve. A total of 769 walk-in patients received GPST consultation and 661 (86%) needed no further ED intervention. Fast discharge was a major determinant of patient satisfaction. No staff expressed dissatisfaction, but some suggested possible improvements in eligibility criteria and built environment design features. Conclusion:Provision of GPST correlated with shorter waits for discharge from ED.

Service evaluation of “GP at Door” of Accident and Emergency Services in Eastern England

“…[13] A pilot GP at Door of A&E (GDAE) service ran at the region's largest acute care centre (Norwich and Norfolk University Hospital, NNUH) from December 2019 to February 2020 and is described elsewhere. [14] The GDAE service hoped to provide patient and system benefits: converting unplanned to planned treatment; providing clinician access to full primary care record which was used in assessment; primary care records to be updated immediately; reduction in unnecessary investigations and more appropriate risk management. The GDAE care pathway is illustrated and described at length elsewhere.…”

“…The GDAE care pathway is illustrated and described at length elsewhere. [14] Patients attending the A&E walk-in entrance (arrival not by ambulance) were met by a GP or ANP who triaged them to the GDAE service or usual A&E care. Bespoke triage criteria were applied according to criteria set out in the Appendix and relying on clinical acumen.…”

What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study

“…7 This led to interventions being rolled out including diverting low-acuity attenders to specially formed colocated general practice (GP) surgeries, and strategies designed to prevent low-acuity attenders from attending the ED. 8 9 However, there is a little evidence 10–12 surrounding the effectiveness of these interventions in improving outcomes compared with care as usual within the ED, and a dearth of evidence around their cost-effectiveness. 13 This study assessed the effect in reducing length of stay in the ED and cost-effectiveness to the NHS of (1) preventing low-acuity attenders from attending the ED and (2) diverting low-acuity attenders at triage to a colocated GP service, using a simulation model of an ED in a single large urban teaching hospital in the UK, as a case study.…”