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Role of out of hours primary care service in limiting inappropriate access to emergency department

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Abstract

Out of hours (OOH) doctors can have an important gate-keeping role over the access to the emergency department (ED), but the outcome and the quality of their ED referrals have been poorly studied. We aimed to investigate the outcome of patients referred to ED from OOH service and the determinants of admission or short-stay dispositions. We collected retrospectively data about referrals to ED from a local OOH service in the north-east of Italy using the OOH paper register and the ED electronic database, over the period of 01/10/2012 to 31/03/2013. Out of 5217 patients accessing the OOH service, 408 referrals were included in our analysis. 45.3% (185) of the referrals were admitted to hospital or the short-stay unit, 26 patients (=6.4%) were discharged as non-urgent outgoing codes after no specialist consultation or test, suggesting inappropriate referrals, and, of the remaining 197 (=48%), only 10 did not undergo any investigation or consultation. Significant determinants of admission were: age ≥65 years (OR = 2.619; 95% CI 1.528–4.491, p < 0.0001), domiciliary examination (OR = 2.168; 95% CI 1.353–3.476, p = 0.001), nursing home/palliative care setting (OR = 2.563; 95% CI 1.228–5.351, p = 0.012) and OOH triage code, ranging from an OR of 7.47 (95% CI 3.028–18.433) for minor urgencies to an OR of 26.835 (95% CI 6.761–106.508, p < 0.0001) for emergencies, in comparison to no urgent codes. OOH service seems to play an effective gate-keeping role limiting ED access. Determinants of admission to hospital suggest some simple interventions that could improve the adequacy of ED referral from OOH service.

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Acknowledgements

We are very grateful to Dr. John O’ Malley for the contribution to the English language editing.

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Author notes

  1. Andrea Posocco and Maria Paola Scapinello equally contributed to this research.

Authors and Affiliations

  1. Unità Locale Socio Sanitaria 2 “Marca Trevigiana”, Treviso, Continuità Assistenziale di Vittorio Veneto (TV), Vittorio Veneto (TV), Italy

    Andrea Posocco, Maria Paola Scapinello, Irene De Ronch, Francesco Castrogiovanni, Gianluca Lollo, Guglielmo Sergi, Iginio Tomaselli, Loris Tonon, Daniele Pescador, Elena Battistuz, Stefano Traversa, Vincenzo Zambianco & Nicola Veronese

  2. Scuola di Formazione Specifica in Medicina Generale, Regione Veneto, Venice, Italy

    Andrea Posocco

  3. Department of Neurosciences, University of Padova, Padua, Italy

    Marco Solmi

  4. Neuroscience Institute, Aging Branch, National Research Council, Via Giustiniani 2, 35128, Padua, Italy

    Nicola Veronese

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  1. Andrea Posocco
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  2. Maria Paola Scapinello
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  3. Irene De Ronch
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Corresponding author

Correspondence to Nicola Veronese.

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Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All patients enrolled in the study have read and signed the informed consent.

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No source of funding.

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The datasets analysed during the current study are available from the corresponding author on request.

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Posocco, A., Scapinello, M.P., De Ronch, I. et al. Role of out of hours primary care service in limiting inappropriate access to emergency department. Intern Emerg Med 13, 549–555 (2018). https://doi.org/10.1007/s11739-017-1679-8

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  • DOI: https://doi.org/10.1007/s11739-017-1679-8

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