The Development and Performance of After-Hours Primary Care in the Netherlands

Smits, Marleen; Rutten, Mcm Marcel; Keizer, Ellen; Wensing, Michel; Westert, Gert P.; Giesen, Paul

doi:10.7326/m16-2776

Cited by 114 publications

(132 citation statements)

References 27 publications

Supporting

Mentioning

118

Contrasting

Unclassified

Order By: Relevance

“…Telephone triage is the gateway to medical help for patients in primary care in the Netherlands (Smits et al, ). Accurate triage is of vital importance, specifically for the identification of highly urgent cases, such as patients who are suspected of having an acute cardiac event (Bosner et al, ; Rawshani et al, ).…”

Section: Introductionmentioning

confidence: 99%

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives To understand clinical reasoning and decision‐making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. Background In telephone triage, nurses assess the urgency of callers’ conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. Design Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. Methods Audio‐stimulated recall interviews were conducted amongst twenty‐four telephone triage nurses at nine out‐of‐hours primary care centres (OHS‐PC). Results Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal—but not worded—elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses’ decision‐making, is essential for the CDSS’ value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. Conclusion Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision‐making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS‐PC. Relevance to clinical practice Triage nurses’ reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS‐PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

show abstract

Section: Introductionmentioning

confidence: 99%

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Wouters

Zwart

Erkelens

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…In the Netherlands, GPCs and emergency departments (EDs) are increasingly working together after‐hours, creating emergency care access points (ECAPs). This is one access point for out‐of‐hours emergency care for all patients . At an ECAP, GPs at the GPCs are responsible for triage .…”

Section: Introductionmentioning

confidence: 99%

“…This is one access point for out-of-hours emergency care for all patients. 3,4 At an ECAP, GPs at the GPCs are responsible for triage. 5,6 Triage will determine whether patients will be seen by the GP or a specialist at the ED.…”

Section: Introductionmentioning

confidence: 99%

Does X‐ray imaging by GPC at emergency care access points in the Netherlands change patient flow and reduce ED crowding? A cohort study

Bersselaar

Maas

Thijssen

2018

Health Science Reports

View full text Add to dashboard Cite

Objective: Organizing out-of-hours emergency care is a challenge in many countries. In the Netherlands, general practitioner cooperatives (GPCs) and emergency departments (EDs) are increasingly working together, creating one emergency care access point (ECAP). This has redirected the majority of patients with musculoskeletal problems from the ED to the GPC in out-of-hours care, due to the treatment of self-referrals by the general practitioner (GP). Only a minority of the GPs at ECAPs have the possibility to request X-rays, and expanding these facilities could reduce patient presentations to the ED even more. The aim of our study was to explore patient flow and possible reductions in ED referrals at an ECAP with X-ray facilities for GPs.Methods: This retrospective cohort study examines all patients that visited an ECAP at a general city hospital in the Netherlands and had an X-ray imaging requested by the GPC between January 1, 2014 and December 31, 2014. General practitioner cooperatives could request X-rays between 5 pm and 10 pm on weekdays and between 8 am and 10 pm during weekends.Recorded data included sex, age, number and type of X-ray, X-ray abnormalities, referral to the ED, and treatment. The annual number of patients presenting to the GPC and ED in 2014 were gathered. Patient outcome was stated negative when the X-ray revealed no abnormality.Results: A total of 2243 patients received 2663 X-ray examinations. The mean age was 31 years and 48% was male. A total of 1517 (68%) patients were treated at the GPC without an ED referral, a reduction of 4.5% of the annual ED patients. Conclusions:With a majority (68%) of the patients examined and treated at the GPC, X-ray facilities at ECAPs will substantially reduce ED population, change patient flow, and have a positive effect on ED crowding. Implementing 24/7 X-ray facilities at all ECAPs will further enhance these effects. KEYWORDSafter-hours care, crowding, emergency department, general practitioner cooperative, primary health care, X-raysThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

show abstract

“…Crowding of patients at emergency departments (EDs), excessive demands on the emergency medical services (EMS) [1][2][3] and more frequent use of out-of-hours primary care (OOH-PC) are widespread in many countries [4]. The high demand may have several negative effects: high use of resources, increased healthcare costs and high workload for healthcare professionals.…”

Section: Introductionmentioning

confidence: 99%

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Huibers¹,

Carlsen²,

Moth³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

show abstract

The Development and Performance of After-Hours Primary Care in the Netherlands

Cited by 114 publications

References 27 publications

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event

Does X‐ray imaging by GPC at emergency care access points in the Netherlands change patient flow and reduce ED crowding? A cohort study

Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

Contact Info

Product

Resources

About