The Impact on Emergency Department Utilization and Patient Flows after Integrating with a General Practitioner Cooperative : An Observational Study

Abstract EN

Introduction.

A new model, an emergency care access point (ECAP) for after-hours emergency care, is emerging in The Netherlands.

This study assessed the effect on emergency department (ED) utilization and patient flows.

Methods.

Routinely recorded clinical ED patient data, covering a six-year period, was collected.

Segmented regression analysis was used to analyze after-hours changes over time.

Results.

59.182 patients attended the ED before the start of the ECAP and 51.513 patients after, a decrease of 13%.

Self-referred ED patients decreased 99.5% (OR 0.003; 95% CI 0.002–0.004).

Referred patients increased by 213.4% and ED hospital admissions increased by 20.2%.

A planned outpatient follow-up increased by 5.8% (OR 1.968 95% CI 1.870–2.071).

The latter changed from fewer contacts to more contacts (OR 1.015 95% CI 1.013–1.017).

Consultations at the regional genereral practitioner cooperative (GPC) increased by 26.0% (183.782 versus 232.246).

Conclusion.

ECAP implementation resulted in a decrease in ED utilization, a near absence of self-referring patients, and a higher probability of hospital admission and clinical follow-up.

This suggests either an increase of ED patients with a higher acuity or a lower threshold of admitting referred patients compared to self-referred patients.

Overall, increased collaboration with after-hours primary care and emergency care seemed to optimize ED utilization.