DOI: 10.1097/MEJ.0b013e3282fc7648
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PMID: 19078846
Issn Print: 0969-9546
Publication Date: 2008/12/01
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Excerpt
During a Foundation Year 2 Post in General Practice, I looked at attendances of patients in a practice of 10 500 patients. This practice was located in a multicultural urban area of Luton, with a high Index of Multiple Deprivation 2004 (indicating low socioeconomic conditions).
I retrospectively reviewed all attendances to ED in the month of August 2007, as notified to us by medical documentation. From these, data were collected on time of attendance, whether investigations included radiographs or ECG and also on outcome of attendance. Practice records were reviewed to check whether the patient had previously presented with the same complaint to the surgery, and the average time since the patient's previous consultation.
The practice was notified of 51 attendances to ED. The mean age of attending patients was 34.8 years. Only 49% of visits occurred out of hours, whereas the remaining 51% attended during surgery opening hours. Eight patients (15.7%) had attended previously to the practice with the same complaint. The mean time between consultation for any complaint and attending ED was 7.05 weeks.
A total of 22 patients (43.1%) had either an ECG or radiograph performed. Only three patients (5.8%) were either admitted or referred for specialist opinions. A total of 27 patients (52.9%) received some treatment and were discharged, whereas 21 (41.1%) were discharged without treatment.
Although there was a low frequency of ED attendances on August 2007, these figures do highlight significant challenges. Just over half of the attendances took place during surgery opening hours and the challenge remains how best to tackle this.
In this particular surgery, over half of the appointments with doctors can only be booked on the same day, to allow access for patients with urgent queries. These include short 5-min appointments specifically for minor urgent complaints that may otherwise attend ED. A practice nurse service trained to provide treatment and advice for minor illnesses and a local walk-in centre during surgery opening hours are also available. Out of hours, alternative services exist such as the out-of-hours general practitioner service and urgent care centres.
The fact that 41.1% were discharged without treatment, whereas only 5.8% were admitted or referred suggests that many of these patients could be adequately assessed and treated in the general practice setting.
The mean length of time between last general practice consultation and ED attendance suggests that not all these patients are regular attendees to general practice. As such, changing patients' attitudes and perceptions about where and when to attend for urgent care seems to be the principal obstacle for reducing avoidable ED attendances.
