Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain

O’Cathain, Alicia; Simpson, Rebecca; Phillips, Melissa S.; Knowles, EL

doi:10.1136/emermed-2020-210271

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…20 Access to timely care is one key reason that patients choose to attend the ED for more minor problems. 161,162 Our marker conditions analysis suggested that people most likely to have minor problems (requiring no investigations or treatment) would be seen in a more timely fashion by GPs than by ED clinicians. However, this impact did not extend beyond this small proportion of overall ED attendances to influence LOS in the ED for the whole department.…”

Section: Patient Satisfactionmentioning

confidence: 95%

“…162 While patient-reported reasons for attending EDs are often related to limited or poor access to primary care, an analysis of routine data found that there was no statistically significant relationship between the number of GPs in a primary care trust area and the number of emergency admissions. 162,173 While patient-reported reasons for attending EDs are often related to limited or poor access to primary care, an analysis of routine data found that there was no statistically significant relationship between the number of GPs in a primary care trust area and the number of emergency admissions. 173 However, in deprived areas, a higher number of GPs was associated with reduced emergency admission.…”

Section: Patient Safety Implicationsmentioning

confidence: 99%

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Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Davies,

Edwards,

Price

et al. 2024

Health Soc Care Deliv Res

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Background Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner–emergency department service models. Objectives To evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner–emergency department models. Design Mixed-methods realist evaluation. Methods Phase 1 (2017–8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018–21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost–consequences analysis of routine data; and case site data for ‘marker condition’ analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021–2), to conduct mixed-methods analysis for programme theory and toolkit development. Results General practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner–emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner–emergency department models. Limitations The quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with ‘marker conditions’). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as ‘telephone first’ and their relevance to our findings remains unexplored. Conclusion Findings suggest that general practitioner–emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner–emergency department services. Future work The emergency care data set has since been introduced across England to help standardise data collection to facilitate further research. We would advocate the systematic capture of patient experience measures and patient-reported outcome measures as part of routine care. More could be done to support the development of the general practitioner in emergency department role, including a core set of competencies and governance structure, to reflect the different general practitioner–emergency department models and to evaluate the effectiveness and cost effectiveness to guide future policy. Study registration This study is registered as PROSPERO CRD42017069741. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/145/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 10. See the NIHR Funding and Awards website for further award information.

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Section: Patient Satisfactionmentioning

confidence: 95%

Section: Patient Safety Implicationsmentioning

confidence: 99%

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Davies,

Edwards,

Price

et al. 2024

Health Soc Care Deliv Res

View full text Add to dashboard Cite

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“…As over half of older people accessing ED are admitted to a ward,9 and prolonged hospitalisation in this population are associated with adverse risks12 and future re-admissions,13 rapid assessment and treatment models of care could be beneficial for global public health systems that are experiencing high ED usage in general,1 2 but also specifically in terms of treating older people 3–5. The introduction of specialised geriatric urgent care services could also improve patients and relatives user experience and may mitigate some of the concerns older people report regarding accessing acute care 7…”

Section: Discussionmentioning

confidence: 99%

“…In Australia, emergency healthcare demands are increasing,2 with older Australians disproportionately presenting to ED for non-emergency conditions compared with other age groups 3. This trend appears to be international 4 5. A large proportion of older people have reported negative experiences with EDs, leading to a reluctance to re-attend 6–8.…”

Section: Introductionmentioning

confidence: 99%

Evaluating a new emergency department avoidance service for older people: patient and relative experiences

et al. 2023

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BackgroundHigh emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged 65 and above, the Southern Adelaide Local Health Network introduced an innovative ED avoidance service. This study assessed the acceptability of the service among its users.MethodThe Complex And RestorativE (CARE) Centre is a six-bed unit staffed by a multidisciplinary geriatric team. Patients are transported directly to CARE after calling for an ambulance and being triaged by a paramedic. The evaluation took place between September 2021 and September 2022. Semi-structured interviews were conducted with patients and relatives who had accessed the service. Data analysis was performed using a six-step thematic analysis.ResultsSeventeen patients and 15 relatives were interviewed, who described the experience of 32 attendances to the urgent CARE centre between them. Patients accessed the service for several reasons but over half were associated with falls. There was a hesitation to call emergency services for several reasons, the primary being long wait times in ED and/or the prospect of an overnight stay in hospital. Some individuals attempted to contact their General Practitioner (GP) for the presenting problem but were unable to get a timely appointment. Most participants had previously attended a local ED and had a negative experience. All individuals reported favouring the CARE centre over the traditional ED for numerous reasons including a quieter and safer environment and specially trained geriatric staff who were less rushed than ED staff. Several participants would have appreciated a standardised follow-up process after discharge.ConclusionOur findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience.

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Variations in the intended utilization of emergency care in case of gastrointestinal diseases

Klein,

Koens,

Scherer

et al. 2024

Health Policy

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Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain

Cited by 7 publications

References 15 publications

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation

Evaluating a new emergency department avoidance service for older people: patient and relative experiences

Variations in the intended utilization of emergency care in case of gastrointestinal diseases

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