Abstract
ObjectiveOrganizing 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.MethodsThis 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.ResultsA 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.ConclusionsWith 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.
Highlights
Organizing out‐of‐hours emergency care is an important challenge in many countries
This retrospective cohort study examines all patients that visited an emergency care access point (ECAP) at a general city hospital in the Netherlands and had an X‐ray imaging requested by the General Practitioner Cooperative (GPC) between January 1, 2014 and December 31, 2014
A total of 1517 (68%) patients were treated at the GPC without an Emergency Department (ED) referral, a reduction of 4.5% of the annual ED patients
Summary
Since 2000, primary care settings in many European countries have changed from rota‐groups towards general practitioner cooperatives (GPCs).[1,2] 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.[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. This gatekeeping function of GPs is seen as efficient patient care.[3]
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