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The impact of general practitioners working in or alongside emergency departments: a rapid realist review / 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
BMJ Open, Volume: 9, Issue: 4, Start page: e024501
Swansea University Author: Anderson, Pippa
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AbstractOBJECTIVES: Worldwide, emergency care is under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%-43% of emergency department patients could be treated by primary care services. In England, this has led...
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AbstractOBJECTIVES: Worldwide, emergency care is under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%-43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are 'free to care for the sickest patients'. However, the research evidence to support this initiative is weak.DESIGN:Rapid realist literature review.SETTING:Emergency departments.INCLUSION CRITERIA:Articles describing general practitioners working in or alongside emergency departments.AIM:To develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.RESULTS:Ninety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.CONCLUSIONS:Multiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.
emergency service, hospital; general practitioners; health services research; primary health care
College of Human and Health Sciences