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To ED or not to ED: NHS 24 referrals to the emergency department
  1. Ronald Cook1,
  2. Shobhan Thakore1,
  3. William Morrison1,
  4. J Meikle2
  1. 1Emergency Medicine, Ninewells Hospital, Dundee, UK
  2. 2Out-of-Hours Primary Care, NHS Tayside, Dundee, UK
  1. Correspondence to Dr Ronald Cook, Emergency Department, Ninewells Hospital, Dundee DD1 9SY, UK; ronald.cook{at}


Introduction This study aimed to compare the opinions of consultants in emergency medicine and general practitioners (GPs) on the appropriateness of NHS 24 referrals to the emergency department (ED).

Methods 170 NHS 24 referrals to the ED were reviewed by six GPs and six emergency consultants who were asked their opinion as to which out-of-hours service would be most appropriate for the patient. Modal responses from both groups were calculated for each referral. Consensus within groups and levels of agreement were calculated.

Results Modal responses agreed with an ED disposal in 59.2% of cases in the emergency consultant group with a 90% consensus rate. The GP group agreed with an ED disposal in only 47% of cases with a 75.9% consensus rate. A primary care referral response was the mode in 20.8% of the emergency consultant group compared with 35.7% in the GP group. Consensus was reached in 76.3% of the emergency consultant responses and 81.7% of GP responses. The difference in opinion between the two study groups was statistically significant.

Conclusions GPs and consultants in emergency medicine both believe a high proportion of NHS 24 referrals to the ED should be handled by primary care services. This would suggest that, compared with previous out-of-hours practice, NHS 24 favours an ED outcome. The results indicate a large proportion of primary care patients are being handled inappropriately and uneconomically in the ED setting. There is a need for ongoing improvement of the telephone triage service provided by NHS 24.

  • NHS 24
  • out-of-hours care
  • emergency medicine
  • telephone triage
  • emergency care systems
  • primary care
  • emergency departments
  • emergency medicine

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  • Funding A total of £1928 funding was received from EastRen, East of Scotland Primary Care Research Network. EastRen had no involvement in the design, writing or decision to submit this article for publication.

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  • Competing interests None.

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  • Provenance and peer review Not commissioned; externally peer reviewed.

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