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Abstract
Aims and Objectives Patients may attend the emergency department(ED) following referral from general practice(GP). With increasingly complex secondary care pathways and congested EDs, improved collaboration between senior decision makers in the ED and GP can help to promote inter-specialty working, prevent duplication of work, and streamline patient care. This study aimed to evaluate the impact of a new referral pathway for patients presenting to GP who required secondary care, expanding on an established Community Emergency Medicine(CEM) model.
Method and Design This was a prospective interventional study. The intervention was a three month pilot whereby GPs discussed patient referrals with an ED consultant based at the REACH (Remote Emergency Access Coordination Hub), an established CEM model providing telephone and video advice and consultations to 111 and 999 calls. The REACH consultant could, where appropriate, suggest alternate care pathways or accept the patient into the ED with investigations and specialty referrals front-loaded. Qualitative and quantitative data from approximately 4200 patients were analyzed by 11 researchers, including snapshots from three ‘pre-pilot’ days (control), and three ‘pilot’ days (intervention). The population included adults who had a GP consultation (virtual or face-to-face) within seven days of ED attendance. The primary outcome examined how streamlined the patient pathway was i.e. how many areas of the ED or clinician contacts the patient experienced before definitive care was arranged. Secondary outcomes included GP and ED clinician satisfaction.
Results and Conclusion 76.9% ED consultants and 58.1% GPs felt that the intervention was valuable. In conclusion, this study found that discussion between GPs and ED consultants regarding patient referrals to the ED led to more streamlined patient care and increased clinician satisfaction. This adds to a growing evidence base of the benefits of CEM models and the need for emergency care to be recognised as a continuum defined by patient need rather than the four walls of an ED.
