Hospital‐integrated general practice: a promising way to manage walk‐in patients in emergency departments. Issue 1 (28th August 2013)

• Record Type: Journal Article
• Authors: Wang, Mathyas; Wild, Stefanie; Hilfiker, Gabriela; Chmiel, Corinne; Sidler, Patrick; Eichler, Klaus; Rosemann, Thomas; Senn, Oliver
• Is Part Of: Journal of evaluation in clinical practice. Volume 20:Issue 1(2014)
• Page Start: 20
• Page End: 26
• Publication Date: 2013-08-28
• Subjects: Clinical medicine -- Periodicals; 616.005
• DOI: 10.1111/jep.12074
• Languages: English
• ISSNs: 1356-1294

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jep12074-sec-0001" sec-type="section"> <title>Rationale, aims and objectives</title> <p>The inappropriate use and overcrowding of emergency departments (EDs) by walk‐in patients are well‐known problems in many countries. The current study aimed to determine whether ambulatory walk‐in patients could be treated more efficiently in a new hospital‐integrated general practice (HGP) for emergency care services compared to a traditional ED.</p> </sec> <sec id="jep12074-sec-0002" sec-type="section"> <title>Methods</title> <p>We conducted a pre‐post comparison before and after the implementation of a new HGP. Participants were walk‐in patients attending the ED of a city hospital in Zurich. Main outcome measures were differences in total process time, time intervals between stages of care and diagnostic resources used.</p> </sec> <sec id="jep12074-sec-0003" sec-type="section"> <title>Results</title> <p>The median process time from admission to discharge was 120 minutes in the ED [interquartile range (IQR): 80–165] versus 60 minutes in the HGP (IQR: 40–90) (<italic>P</italic> < 0.001). The adjusted odds ratio of receiving any additional diagnostics was 1.86 (95% confidence interval 1.06–3.27; <italic>P</italic> = 0.032) for ED doctors versus general practitioners (GPs) when controlling for patients' age, sex and injury‐related medical problems.</p> </sec> <sec id="jep12074-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The HGP is an efficient way to manage walk‐in patients with regard to process time and utilization of additional diagnostic resources. The involvement of GPs in the HGPs should be considered as a promising model to overcome the inappropriate use of resources in EDs for walk‐in patients who can be treated by ambulatory care.</p> </sec> </abstract>