School of Health and Related Research, The University of Sheffield, Sheffield, UK.
Sheffield Children's Hospital and Sheffield Teaching Hospital, Western Bank, Sheffield, UK.
Emerg Med J. 2017 Oct;34(10):672-676. doi: 10.1136/emermed-2016-206539. Epub 2017 May 9.
Co-location of primary care services with Emergency Departments (ED) is one initiative aiming to reduce the burden on EDs of patients attending with non-urgent problems. However, the extent to which these services are operating within or alongside EDs is not currently known.This study aimed to create a typology of co-located primary care services in operation across Yorkshire and Humber (Y&H) as well as identify early barriers and facilitators to their implementation and sustainability.
A self-report survey was sent to the lead consultant or other key contact at 17 EDs in the Y&H region to establish the extent and configuration of co-located primary care services. Semi-structured interviews were then conducted with urgent and unscheduled care stakeholders across five hospital sites to explore the barriers and facilitators to the formation and sustainability of these services.
Thirteen EDs completed the survey and interviews were carried out with four ED consultants, one ED nurse and three general practitioners (GPs). Three distinct models were identified: 'Primary Care Services Embedded within the ED' (seven sites), 'Co-located Urgent Care Centre' (two sites) and 'GP out-of-hours' (nine sites). Qualitative data were analysed using framework analysis. Four interview themes emerged (justification for the service, level of integration, referral processes and sustainability) highlighting some of the challenges in implementing these co-located primary care services.
Creating a service within or alongside the ED in which GPs can use their distinct skills and therefore add value to the existing skill mix of ED staff is an important consideration when setting up these systems. Effective triage arrangements should also be established to ensure appropriate patients are referred to GPs. Further research is required to identify the full range of models nationally and to carry out a rigorous assessment of their impact.
将初级保健服务与急诊部（ED）合作是旨在减轻因非紧急问题而就诊的患者对 ED 负担的一项举措。然而，目前尚不清楚这些服务在 ED 内部或旁边的运作程度。本研究旨在为约克郡和亨伯（Y＆H）地区运营的合作初级保健服务创建一个分类法，并确定其实施和可持续性的早期障碍和促进因素。
向 Y＆H 地区的 17 个 ED 的首席顾问或其他主要联系人发送了一份自我报告调查，以确定合作初级保健服务的范围和配置。然后在五个医院站点与紧急和非计划护理利益相关者进行了半结构化访谈，以探讨这些服务形成和可持续性的障碍和促进因素。
有 13 个 ED 完成了调查，并对 4 个 ED 顾问，1 个 ED 护士和 3 名全科医生（GP）进行了访谈。确定了三种不同的模式：“嵌入 ED 的初级保健服务”（7 个站点），“合作式紧急护理中心”（2 个站点）和“GP 非工作时间”（9 个站点）。使用框架分析对定性数据进行了分析。出现了四个访谈主题（服务的理由，整合程度，转诊流程和可持续性），突出了实施这些合作式初级保健服务所面临的一些挑战。
在 ED 内部或旁边创建一个服务，其中 GP 可以利用其独特的技能并为 ED 员工现有的技能组合增添价值，这是设置这些系统时的重要考虑因素。还应建立有效的分诊安排，以确保将适当的患者转介给 GP。需要进一步研究以确定全国范围内的各种模式，并对其影响进行严格评估。
