Brainard Julii, Rice Aiden, Hughes Gareth, Everden Paul
Norwich Medical School, University of East Anglia, Norwich, UK.
North Norfolk Primary Care, Alkmaar House, Alkmaar Way, Norwich, UK.
Prim Health Care Res Dev. 2025 Jan 10;26:e5. doi: 10.1017/S1463423624000707.
We describe activity, outcomes, and benefits after streaming low urgency attenders to eneral practice services at oor of ccident and mergency departments (GDAE).
Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics, and potential benefits when primary care is co-located with A&E departments.
As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes, and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation, and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four-hour key performance indicator was descriptively compared for co-located and similar emergency departments.
Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care are relatively short at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, and 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection, or feeling generally unwell each comprised > 10% of primary reasons for attendance. At James Paget University Hospital, 4.3%, and at Queen Elizabeth Hospital, 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.
我们描述了将低紧急程度的就诊者分流到事故与急诊科（GDAE）一楼的全科医疗服务后的活动、结果和益处。
许多前往急诊科就诊的是针对非紧急健康问题，这些问题由初级保健而非紧急护理临床医生处理可能会更好。当初级保健与急诊科同处一地时，监测服务活动、结果、服务使用者人口统计学特征和潜在益处是很有价值的。
作为一项服务评估，我们描述并分析了英格兰东部两家医院的GDAE使用者、就诊原因、等待时间、结果以及同处一地的急诊科等待时间。使用Pearson卡方检验和加速时间失效模型，比较了每个地点GDAE和普通急诊科就诊者的结果分布、等待时间、就诊原因、贫困程度和年龄组。对同处一地的急诊科和类似急诊科在四小时关键绩效指标方面的表现进行了描述性比较。
每个GDAE每月约接待1025名患者。只有一个地点的普通事故与急诊科（A&E）护理等待时间相对较短。复诊很常见（约占独特患者的11%），75%的GDAE就诊者在到达后1小时内得到诊治，7%最初被分配到GDAE的患者被转回急诊科进行进一步检查，59%的GDAE患者接受治疗并出院，无需进一步治疗或转诊。疼痛、损伤、感染或总体感觉不适各自占就诊主要原因的比例均超过10%。在詹姆斯·佩吉特大学医院，4.3%的GDAE就诊导致转诊至专科健康服务，在伊丽莎白女王医院，这一比例为16.1%。GDAE就诊者比同处一地的急诊科就诊者更年轻，社会贫困程度更高。两个GDAE地点的患者都能很快得到诊治，但专科转诊次数和等待时间存在差异。过程评估可以阐明研究地点之间差异的原因。
