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191 A classification of primary care pathways in emergency departments: a multi-methods study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews
  1. Michelle Edwards1,
  2. Alison Cooper1,
  3. Davies Freya1,
  4. Andrew Carson-Stevens1,
  5. Thomas Hughes2,
  6. Niro Siriwardena3,
  7. Helen Snooks4,
  8. Adrian Edwards1
  1. 1Cardiff University
  2. 2John Radcliffe Hospital
  3. 3Lincoln University
  4. 4Swansea University


Aims/Objectives/Background We aim to describe and classify the predominant streaming pathways on arrival in Emergency Departments (EDs) in England and Wales and explain how they operate in different models of emergency department primary care services. Recent policy has encouraged a method whereby nurses stream from the emergency department front door to GPs working in a separate GP service operating within or alongside an ED. However, there is variation in methods of assessing and streaming patients on arrival at EDs. Conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety, clinical effectiveness. Our findings present a new classification of current streaming pathways from emergency departments to primary care services.

Methods/Design We used a multi-stage method approach, including an online survey completed by 77 EDs across England & Wales, interviews with 21 clinical leads, and finally, undertaking case studies of 13 EDs. Qualitative data were triangulated and analysed using a framework analysis approach.

Results/Conclusions The most common ED pathways to primary care services were: front door streaming before ED registration; streaming inside the ED; or without streaming but GPs selecting patients. Pathways were often adapted, to suit local circumstances such as department layout, patient demand levels, skill mix and interests of GPs practitioners and the accessibility of community primary care services. Pathways to redirect patients with non-urgent primary care problems to community primary care services were also used, with local variation in protocols based on staffing, patient demand and links to community primary care services. Local clinical leads and managers need to consider which pathway(s) may best suit their local context and needs. Consistency of terminology used to describe pathways between EDs and primary care services is necessary for multi-site evaluation, quality improvement and performance measurement.

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