Background Use of specialist healthcare services is increasing.

Aim To evaluate whether alternative healthcare services could reduce the need for admissions to specialist care hospitals.

Design Prospective observational study of emergency referrals for admission to specialist care.

Setting A single out-of-hours primary care centre (OPCC) in Norway.

Method Out-of-hours physicians registered their referrals for hospital admission and stated whether the admission could have been avoided given the availability of six other healthcare services.

Results Of 1083 registered encounters at the OPCC, 152 (14%) were referred for specialist care hospital admission. According to the referring physician, 32 (21%) of these referrals could have been avoided. The most eligible alternatives to such referrals were next-day appointments at a specialist outpatient clinic (11 of 32 referrals), or admission to a community hospital (21 of 32 referrals), or a nursing home (nine of 32 referrals). Respiratory (eight of 32 referrals) and gastrointestinal problems (12 of 32 referrals) were the most common among avoidable admissions.

Conclusions The use of specialist care hospital admission can be reduced if appropriate alternatives are available.