Self-triage at an urgent care collaboration with and without information campaign

Stefan Morreel, MD, PhD; Hilde Philips, MD, PhD; Veronique Verhoeven, MD, PhD

doi:10.5055/jem.2019.0443

Authors

Stefan Morreel, MD, PhD https://orcid.org/0000-0001-6090-2426
Hilde Philips, MD, PhD https://orcid.org/0000-0002-9503-470X
Veronique Verhoeven, MD, PhD https://orcid.org/0000-0002-3708-6501

DOI:

https://doi.org/10.5055/jem.2019.0443

Keywords:

emergency department, primary care, after-hours care, triage

Abstract

Background: Patients in Belgium needing out-of-hours care have two options: the emergency department (ED) or the general practitioner on call. The latter is often organized in a General Practice Cooperative (GPC). At the ED, there is an overload of patients who could be helped more efficiently by the GPC. Research question: What is the proportion of patients switching from the ED to the GPC (called voluntary switchers) with and without an information campaign? What are the characteristics of these patients?

Methods: Single-center prospective intervention trial during the opening hours of the GPC (only weekends: Friday 7.00 pm to Monday 7.00 am). The first 10 weekends there was no intervention. The next 24 weekends, patients in the ED were informed about the out-of-hours care in Belgium. The information contained several topics: characteristics of both services, where to go using examples, practicalities, and costs. This information was distributed through leaflets and broadcasted on a screen in five languages.

Results: During the study period, 7,453 patients entered the ED of which 330 are voluntary switchers. The proportion of voluntary switchers was 1.7 percent before and 5.4 percent after the intervention (p < 0.01). This effect remained stable for 10 more months after the study. The average number of patients presenting at the ED per hour was 3.1, whereas on hours with voluntary switchers was 5.1 (p < 0.01). The age distribution and epidemiological profile of the voluntary switchers resembles the one of primary care patients. The general practicioners (GPs) referred 6 percent of the voluntary switchers back to the ED.

Conclusion: Co-location of the GPC and the ED and informing patients is a meaningful step toward a more profound collaboration.

Author Biographies

Stefan Morreel, MD, PhD

Student, Department ELIZA, University of Antwerpen, Antwerpen, Belgium

Hilde Philips, MD, PhD

Professor, Department ELIZA, University of Antwerpen, Antwerpen, Belgium

Veronique Verhoeven, MD, PhD

Professor, Department ELIZA, University of Antwerpen, Antwerpen, Belgium

References

Soril LJ, Leggett LE, Lorenzetti DL, et al.: Reducing frequent visits to the emergency department: A systematic review of interventions. PLoS One. 2015; 10(4): e0123660.

Van den Heede K, Van de Voorde C: Interventions to reduce emergency department utilisation: A review of reviews. Health Policy. 2016; 120(12): 1337-1349.

Mackway-Jones K, Marsden J, Windle J, et al.: Emergency Triage. 3rd ed. Oxford: Wiley Blackwell, 2014.

Vrijens F, Renard F, Jonckheer P, et al.: The Belgian health system Pprformance report 2012: Snapshot of results and recommendations to policy makers. Health Policy. 2013; 112(1-2): 133-140.

Velt KB, Cnossen M, Rood PPM, et al.: Emergency department overcrowding: A survey among European neurotrauma centres. Emerg Med J. 2018; 35(7): 447-448.

Colliers A, Remmen R, Streffer ML, et al.: Implementation of a general practitioner cooperative adjacent to the emergency department of a hospital increases the caseload for the GPC but not for the emergency department. Acta Clin Belg. 2017; 72(1): 49-54.

van Gils-van Rooij ES, Yzermans CJ, Broekman SM, et al.: Outof- hours care collaboration between general practitioners and hospital emergency departments in the Netherlands. J Am Board Fam Med. 2015; 28(6): 807-815.

van der Straten LM, van Stel HF, Spee FJ, et al.: Safety and efficiency of triaging low urgent self-referred patients to a general practitioner at an acute care post: An observational study. Emerg Med J. 2012; 29(11): 877-881.

Weinick RM, Burns RM, Mehrotra A: Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010; 29(9): 1630-1636.

Carret ML, Fassa AC, Domingues MR: Inappropriate use of emergency services: A systematic review of prevalence and associated factors. Cad Saude Publica. 2009; 25(1): 7-28.

Thompson MI, Lasserson D, McCann L, et al.: Suitability of emergency department attenders to be assessed in primary care: Survey of general practitioner agreement in a random sample of triage records analysed in a service evaluation project. BMJ Open. 2013; 3(12): e003612.

van Veen M, Steyerberg EW, Lettinga L, et al.: Safety of the Manchester triage system to identify less urgent patients in paediatric emergence care: A prospective observational study. Arch Dis Child. 2011; 96(6): 513-518.

Dias RD, Rios IC, Canhada CL, et al.: Using the Manchester triage system for refusing nonurgent patients in the emergency department: A 30-day outcome study. J Emerg Manag. 2016; 14(5): 349-364.

Ramlakhan S, Mason S, O’Keeffe C, et al.: Primary care services located with EDs: A review of effectiveness. Emerg Med J. 2016; 33(7): 495-503.

Giesen P, Franssen E, Mokkink H, et al.: Patients either contacting a general practice cooperative or accident and emergency department out of hours: A comparison. Emerg Med J. 2006; 23(9): 731-734.

van Veelen MJ, van den Brand CL, Reijnen R, et al.: Effects of a general practitioner cooperative co-located with an emergency department on patient throughput. World J Emerg Med. 2016; 7(4): 270-273.

Weiss SJ, Derlet R, Arndahl J, et al.: Estimating the degree of emergency department overcrowding in academic medical centers: Results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med. 2004; 11(1): 38-50.