Are patients who call a primary care office referred to the emergency department by non-healthcare personnel without the input of a physician?

Russell Hill ,Michael Apolinario,Peter B Richman ,Albert L Gest ,Joann Ha,Chris Smith ,Jose Guardiola ,José R Bravo González

doi:10.7717/peerj.1507

Russell Hill , Michael Apolinario + Show 6 more

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https://doi.org/10.7717/peerj.1507

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Abstract

Objective. We hypothesized that a significant percentage of patients who are referred to the Emergency Department (ED) after calling their primary care physician’s (PCP) office receive such instructions without the input of a physician.Methods. We enrolled a convenience sample of stable adults at an inner-city ED. Patients provided written answers to structured questions regarding PCP contact prior to the ED visit. Continuous data are presented as means ± standard deviation; categorical data as frequency of occurrence. 95% confidence intervals were calculated.Results. The study group of 660 patients had a mean age of 41.7 ± 14.7 years and 72.6% had income below $20,000/year. 472 patients (71.51%; 67.9%–74.8%) indicated that they had a PCP. A total of 155 patients (23.0%; 19.9%–26.4%) called to contact their PCP prior to ED visit. For patients who called their PCP office and were directed by phone to the ED, the referral pattern was observed as follows: 31/98 (31.63%; 23.2%–41.4%) by a non-health care provider without physician input, 11/98 (11.2%; 6.2%–19.1%) by a non-healthcare provider after consultation with a physician, 12/98 (12.3%; 7.7%–20.3%) by a nurse without physician input, and 14/98 (14.3%; 8.6%–22.7%) by a nurse after consultation with physician. An additional 11/98, 11.2%; 6.2–19.1%) only listened to a recorded message and felt the message was directing them to the ED.Conclusion. A relatively small percentage of patients were referred to the ED without the consultation of a physician in our overall population. However, over half of those that contacted their PCP’s office felt directed to the ED by non-health care staff.

Highlights

US health care costs and expenditures continue to accelerate with minimal impact by existing dampening measures (National Health Expenditures, 2011; National Hospital Ambulatory Medical Care Survey, 2010) Recent analysis shows that Emergency Department (ED) utilization and other
We found that patients (91/329; 27.7%) with public insurance were significantly more likely to call their PCP prior to the ED visit than patients (7.5%; 25/330) with private or self-pay insurance (OR = 3.4; 2.9–7.4; p < 0.0001)
These findings were further validated in Massachusetts, where a state-wide universal health care system provides a large body of data to examine key public health issues within a captive population (Massachusetts Division of Health Care Finance and Policy, 2004)

Summary

Introduction

US health care costs and expenditures continue to accelerate with minimal impact by existing dampening measures (National Health Expenditures, 2011; National Hospital Ambulatory Medical Care Survey, 2010) Recent analysis shows that ED utilization and other. How to cite this article Hill et al (2016), Are patients who call a primary care office referred to the emergency department by nonhealthcare personnel without the input of a physician? Ever searching for quality improvement and cost reduction, stand as the gatekeeper and safety net for the United States health care system. While the focus of newly implemented health care laws and regulations aim to improve access to health care through universal insurance coverage, this change alone may do little for cost containment and actual ability for patients to have access to their primary physician (PCP)

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