RATIONALE, AIMS AND OBJECTIVES: The inappropriate use and overcrowding of emergency departments (EDs) by walk-in patients are well-known problems in many countries. The current study aimed to determine whether ambulatory walk-in patients could be treated more efficiently in a new hospital-integrated general practice (HGP) for emergency care services compared to a traditional ED. METHODS: We conducted a pre-post comparison before and after the implementation of a new HGP. Participants were walk-in patients attending the ED of a city hospital in Zurich. Main outcome measures were differences in total process time, time intervals between stages of care and diagnostic resources used. RESULTS: The median process time from admission to discharge was 120 minutes in the ED [interquartile range (IQR): 80-165] versus 60 minutes in the HGP (IQR: 40-90) (P < 0.001). The adjusted odds ratio of receiving any additional diagnostics was 1.86 (95% confidence interval 1.06-3.27; P = 0.032) for ED doctors versus general practitioners (GPs) when controlling for patients' age, sex and injury-related medical problems. CONCLUSION: The HGP is an efficient way to manage walk-in patients with regard to process time and utilization of additional diagnostic resources. The involvement of GPs in the HGPs should be considered as a promising model to overcome the inappropriate use of resources in EDs for walk-in patients who can be treated by ambulatory care.
RATIONALE, AIMS AND OBJECTIVES: The inappropriate use and overcrowding of emergency departments (EDs) by walk-in patients are well-known problems in many countries. The current study aimed to determine whether ambulatory walk-in patients could be treated more efficiently in a new hospital-integrated general practice (HGP) for emergency care services compared to a traditional ED. METHODS: We conducted a pre-post comparison before and after the implementation of a new HGP. Participants were walk-in patients attending the ED of a city hospital in Zurich. Main outcome measures were differences in total process time, time intervals between stages of care and diagnostic resources used. RESULTS: The median process time from admission to discharge was 120 minutes in the ED [interquartile range (IQR): 80-165] versus 60 minutes in the HGP (IQR: 40-90) (P < 0.001). The adjusted odds ratio of receiving any additional diagnostics was 1.86 (95% confidence interval 1.06-3.27; P = 0.032) for ED doctors versus general practitioners (GPs) when controlling for patients' age, sex and injury-related medical problems. CONCLUSION: The HGP is an efficient way to manage walk-in patients with regard to process time and utilization of additional diagnostic resources. The involvement of GPs in the HGPs should be considered as a promising model to overcome the inappropriate use of resources in EDs for walk-in patients who can be treated by ambulatory care.
Authors: Pamela Barbadoro; Elena Di Tondo; Vincenzo Giannicola Menditto; Lucia Pennacchietti; Februa Regnicoli; Francesco Di Stanislao; Marcello Mario D'Errico; Emilia Prospero Journal: PLoS One Date: 2015-06-15 Impact factor: 3.240
Authors: Daniel Hausmann; Vera Kiesel; Lukas Zimmerli; Narcisa Schlatter; Amandine von Gunten; Nadine Wattinger; Thomas Rosemann Journal: PLoS One Date: 2019-04-10 Impact factor: 3.240
Authors: Alison Cooper; Freya Davies; Michelle Edwards; Pippa Anderson; Andrew Carson-Stevens; Matthew W Cooke; Liam Donaldson; Jeremy Dale; Bridie Angela Evans; Peter D Hibbert; Thomas C Hughes; Alison Porter; Tim Rainer; Aloysius Siriwardena; Helen Snooks; Adrian Edwards Journal: BMJ Open Date: 2019-04-11 Impact factor: 2.692
Authors: Arabella Scantlebury; Joy Adamson; Chris Salisbury; Heather Brant; Helen Anderson; Helen Baxter; Karen Bloor; Sean Cowlishaw; Tim Doran; James Gaughan; Andy Gibson; Nils Gutacker; Heather Leggett; Sarah Purdy; Sarah Voss; Jonathan Richard Benger Journal: BMJ Open Date: 2022-09-20 Impact factor: 3.006
Authors: Laurie Smith; Yajur Narang; David Taylor-Robinson; Enitan Carrol; Ana Belen Ibarz Pavon; Karl Edwardson; Simon Bowers; Katharine Jones; Steve Lane; Mary Ryan Journal: BMJ Qual Saf Date: 2017-09-29 Impact factor: 7.035