Journal article
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
- Abstract:
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Introduction: Out of hours (OOH) 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 Emergency Department (ED) and on call specialties.
Methods: We studied the variation in referral rates (to the emergency department 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 (1.12.14 – 31.12.2015), 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, 5,261 (4.4%) were sent directly to the ED and 3,474 (3.7%) were admitted directly to specialties. More referrals were made to ED by primary care physicians if they didn’t 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 out of hours 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, 309.0KB, Terms of use)
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- Publisher copy:
- 10.1136/emermed-2020-209527
Authors
- Publisher:
- BMJ
- Journal:
- Emergency Medicine Journal More from this journal
- Volume:
- 38
- Issue:
- 10
- Pages:
- 784-788
- Publication date:
- 2021-03-23
- Acceptance date:
- 2021-01-18
- DOI:
- EISSN:
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1472-0213
- ISSN:
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1472-0205
- Language:
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English
- Keywords:
- Pubs id:
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1159828
- Local pid:
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pubs:1159828
- Deposit date:
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2021-02-02
Terms of use
- Copyright holder:
- Lasserson et al.
- Copyright date:
- 2021
- Rights statement:
- © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
- Notes:
- This is the accepted manuscript version of the article. The final version is available from BMJ Publishing at: http://dx.doi.org/10.1136/emermed-2020-209527
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