Abstract

BackgroundIn an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours GP (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs). Work satisfaction is an important factor in analysing the impact of this organisational change. The objective of this study is, firstly, to discover if there is a difference in the employee experiences between those working in UCCs and those in traditional out-of-hours services in which EDs and out-of-hours GP services operate separately (i.e. “usual care”). Secondly, we would like to identify which factors affect employees’ experiences in these settings.MethodsThis study followed a cross-sectional study design, comparing usual care with UCCs. Data regarding employee experiences were collected from physicians, nurses, nurse practitioners, medical assistants and front desk personnel, by means of a questionnaire with scales regarding quality, workload and co-operation between the out-of-hours GP service and ED. Independent samples t-tests were used to determine mean differences between the settings. Multiple linear regression analyses were performed to test which items affected the perceived quality, workload and co-operation.ResultsThe results showed that mutual co-operation alone was perceived as significantly better in UCCs compared to usual care. If divided between employers, no differences were found in the employee experiences working in out-of-hours GP services. ED employees in UCCs experienced a significantly better co-operation with their GP colleagues than their peers in the usual care setting, but also a higher workload. Remarkably, ED employees were less satisfied in general. The multiple regression model showed that perceived quality, workload and co-operation were interrelated. Co-operation was the only aspect that was rated higher in the UCC setting.ConclusionWhile perceived quality is equal and co-operation between out-of-hours GP service and ED is better, the objective and perceived ED workload was higher in UCCs compared to usual care. Though UCCs relieve the pressure on EDs concerning the number of patients, they seem to aggravate the workload. EDs need to be careful not to excessively adjust staff capacity when responding to lower numbers of patients.

Highlights

  • In an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours general practitioners (GP) (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs)

  • More (65% vs. 52%) support staff members responded in the usual care setting than in UCCs

  • The percentage of male staff in the EDs was higher in the UCC than in the usual care setting

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Summary

Introduction

In an attempt to redirect patients who are inappropriately attending hospital emergency departments (ED) and in doing so provide the right care at the right place, out-of-hours GP (General Practitioner) services and EDs increasingly collaborate in Urgent Care Collaborations (UCCs). Out-of-hours emergency care is generally regarded as one of the most onerous aspects of doctors’ and nurses’ work. In order to have access to hospital care, including EDs, patients are obliged to have a referral from an ambulant emergency service or GP, who functions as a gatekeeper. Outof-hours GP services operate with one fixed budget, based on the catchment population, which is converted to a price per medical service (advice, consultation at care center, consultation at home). The prices for medical services are determined after negotiations between health insurance companies and care providers. As all citizens of the Netherlands are required to have health insurance coverage, every citizen pays for annual healthcare expenditures

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