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Hospital‐integrated general practice: a promising way to manage walk‐in patients in emergency departments
Author(s) -
Wang Mathyas,
Wild Stefanie,
Hilfiker Gabriela,
Chmiel Corinne,
Sidler Patrick,
Eichler Klaus,
Rosemann Thomas,
Senn Oliver
Publication year - 2014
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12074
Subject(s) - overcrowding , interquartile range , medicine , ambulatory , emergency department , confidence interval , odds ratio , emergency medicine , medical emergency , ambulatory care , odds , walk in , emergency medical services , health care , logistic regression , nursing , alternative medicine , pathology , economics , economic growth
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 Z urich. 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.