Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals? A retrospective observational study.

Gaughan, J; Liu, D; Gutacker, N; Bloor, K; Doran, T; Benger, JR

Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals? A retrospective observational study.

Gaughan, J Liu, D

Gutacker, N Bloor, K Doran, T Benger, JR

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Publisher:: BMJ
Publication Type:: Journal Article
Citation:: BMJ Open, 2022, 12, (2), pp. e055976
Issue Date:: 2022-02-23

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Field	Value	Language
dc.contributor.author	Gaughan, J
dc.contributor.author	Liu, D https://orcid.org/0000-0002-1891-9352
dc.contributor.author	Gutacker, N
dc.contributor.author	Bloor, K
dc.contributor.author	Doran, T
dc.contributor.author	Benger, JR
dc.date.accessioned	2022-08-23T05:46:03Z
dc.date.available	2022-08-23T05:46:03Z
dc.date.issued	2022-02-23
dc.identifier.citation	BMJ Open, 2022, 12, (2), pp. e055976
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/160746
dc.description.abstract	OBJECTIVES: Emergency departments (EDs) in NHS hospitals in England have faced considerable increases in demand over recent years. Most hospitals have developed general practitioner services in emergency departments (GPEDs) to treat non-emergency patients, aiming to relieve pressure on other staff and to improve ED efficiency and patient experience. We measured the impact of GPED services on patient flows, health outcomes and ED workload. DESIGN: Retrospective observational study. Differences in GPED service availability across EDs and time of day were used to identify the causal effect of GPED, as patients attending the ED at the same hour of the day are quasi-randomly assigned to treatment or control groups based on their local ED's service availability. PARTICIPANTS: Attendances to 40 EDs in English NHS hospitals from April 2018 to March 2019, 4 441 349 observations. PRIMARY AND SECONDARY OUTCOMES MEASURED: Outcomes measured were volume of attendances, 'non-urgent' attendances, waiting times over 4 hours, patients leaving without being treated, unplanned reattendances within 7 days, inpatient admissions and 30-day mortality. RESULTS: We found a small, statistically significant reduction in unplanned reattendances within 7 days (OR 0.968, 95% CI 0.948 to 0.989), equivalent to 302 fewer reattendances per year for the average ED. The clinical impact of this was judged to be negligible. There was no detectable impact on any other outcome measure. CONCLUSIONS: We found no adverse effects on patient outcomes; neither did we find any evidence of the hypothesised benefits of placing GPs in emergency settings beyond a marginal reduction in reattendances that was not considered clinically significant.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2021-055976
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	General Practitioners
dc.subject.mesh	Hospitals
dc.subject.mesh	Humans
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	State Medicine
dc.subject.mesh	Humans
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Emergency Service, Hospital
dc.subject.mesh	Hospitals
dc.subject.mesh	State Medicine
dc.subject.mesh	General Practitioners
dc.title	Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals? A retrospective observational study.
dc.type	Journal Article
utslib.citation.volume	12
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	open_access	*
dc.date.updated	2022-08-23T05:45:53Z
pubs.issue	2
pubs.publication-status	Published online
pubs.volume	12
utslib.citation.issue	2

Abstract:

OBJECTIVES: Emergency departments (EDs) in NHS hospitals in England have faced considerable increases in demand over recent years. Most hospitals have developed general practitioner services in emergency departments (GPEDs) to treat non-emergency patients, aiming to relieve pressure on other staff and to improve ED efficiency and patient experience. We measured the impact of GPED services on patient flows, health outcomes and ED workload. DESIGN: Retrospective observational study. Differences in GPED service availability across EDs and time of day were used to identify the causal effect of GPED, as patients attending the ED at the same hour of the day are quasi-randomly assigned to treatment or control groups based on their local ED's service availability. PARTICIPANTS: Attendances to 40 EDs in English NHS hospitals from April 2018 to March 2019, 4 441 349 observations. PRIMARY AND SECONDARY OUTCOMES MEASURED: Outcomes measured were volume of attendances, 'non-urgent' attendances, waiting times over 4 hours, patients leaving without being treated, unplanned reattendances within 7 days, inpatient admissions and 30-day mortality. RESULTS: We found a small, statistically significant reduction in unplanned reattendances within 7 days (OR 0.968, 95% CI 0.948 to 0.989), equivalent to 302 fewer reattendances per year for the average ED. The clinical impact of this was judged to be negligible. There was no detectable impact on any other outcome measure. CONCLUSIONS: We found no adverse effects on patient outcomes; neither did we find any evidence of the hypothesised benefits of placing GPs in emergency settings beyond a marginal reduction in reattendances that was not considered clinically significant.

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http://hdl.handle.net/10453/160746