CREDIT: This story was first seen in OnMeidca
Locating a GP in a hospital emergency department (ED) can reduce waiting times and admissions, but may increase antibiotic prescribing, says a study published in the journal BMJ Quality and Safety*.
In October 2014 a GP service co-located in the emergency department from 14:00 to 22:00 hours, seven days a week, at Alder Hey Children’s Hospital, one of Europe’s busiest paediatric emergency departments. Children triaged green on the Manchester Triage System without any comorbidities were classed as ‘GP appropriate’, OnMeidca reports.
The researchers compared patients triaged as ‘GP appropriate’ and able to be seen by a GP between 14:00 and 22:00 hours (GP group) to patients triaged as ‘GP appropriate’ outside these hours when a GP was available (ED group) who were seen by emergency department staff.
A total of 5,223 patients were designated as ‘GP appropriate’ — 18.2% of the total attendances to the emergency department over the study period. Of these 2,821 (54%) were in the GP group and 2,402 (46%) in the ED group. The median duration of stay in the ED was 94 minutes for the GP group compared with 113 minutes for the ED group.
Analysis showed that the GP group were less likely to: be admitted to hospital (2.2% versus 6.5%), wait longer than 4 hours (2.3% versus 5.1%) or leave before being seen (3.1% versus 5.7%), but more likely to receive antibiotics (26.1% versus 20.5%).
Professor Taylor-Robinson of the University’s Institute of Psychology, Health and Society, one of the study leaders, said: “During this six-month period patients seen during the hours when the GP was available were significantly less likely to be admitted, exceed the four-hour waiting target or leave before being seen. However, they were more likely to receive antibiotics.
“The results presented in this study highlight both the advantages and challenges that can arise when integrating a GP service within a busy paediatric ED. Integrative approaches are currently being seen as a plausible solution to meet the needs of overstretched healthcare services, and further research is needed to guide an evidence-guided decision.”