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Variation in referral rates to emergency departments and inpatient services from a GP out of hours service and the potential impact of alternative staffing models
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Lasserson, D. S., Smith, H. K., Garland, S., Hunt, H. and Hayward, G. N. (2021) Variation in referral rates to emergency departments and inpatient services from a GP out of hours service and the potential impact of alternative staffing models. Emergency Medicine Journal, 38 (10). pp. 784-788. doi:10.1136/emermed-2020-209527 ISSN 1472-0205.
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Official URL: https://doi.org/10.1136/emermed-2020-209527
Abstract
Introduction Out of hours (OOHs) primary care is a critical component of the acute care system overnight and at weekends. Referrals from OOH services to hospital will add to the burden on hospital assessment in the ED and on-call specialties.
Methods We studied the variation in referral rates (to the ED and direct specialty admission) of individual clinicians working in the Oxfordshire, UK OOH service covering a population of 600 000 people. We calculated the referral probability for each clinician over a 13-month period of practice (1 December 2014 to 31 December 2015), stratifying by clinician factors and location and timing of assessment. We used Simul8 software to determine the range of hospital referrals potentially due to variation in clinician referral propensity.
Results Among the 119 835 contacts with the service, 5261 (4.4%) were sent directly to the ED and 3474 (3.7%) were admitted directly to specialties. More referrals were made to ED by primary care physicians if they did not work in the local practices (5.5% vs 3.5%, p=0.011). For clinicians with >1000 consultations, percentage of patients referred varied from 1% to 21% of consultations. Simulations where propensity to refer was made less extreme showed a difference in maximum referrals of 50 patients each week.
Conclusions There is substantial variation in clinician referral rates from OOHs primary care to the acute hospital setting. The number of patients referred could be influenced by this variation in clinician behaviour. Referral propensity should be studied including casemix adjustment to determine if interventions targeting such behaviour are effective.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RT Nursing |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Primary care (Medicine) -- Research, Emergency medicine -- Research, Emergency nursing -- Research, Family medicine -- Research | |||||||||
Journal or Publication Title: | Emergency Medicine Journal | |||||||||
Publisher: | BMJ Group | |||||||||
ISSN: | 1472-0205 | |||||||||
Official Date: | 20 September 2021 | |||||||||
Dates: |
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Volume: | 38 | |||||||||
Number: | 10 | |||||||||
Page Range: | pp. 784-788 | |||||||||
DOI: | 10.1136/emermed-2020-209527 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Re-use Statement: | This article has been accepted for publication in Emergency Medicine Journal, 2021 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/emermed-2020-209527 © Authors (or their employer(s)) OR “© BMJ Publishing Group Ltd | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 21 January 2021 | |||||||||
Date of first compliant Open Access: | 30 March 2021 | |||||||||
RIOXX Funder/Project Grant: |
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