School of Primary, Aboriginal and Rural Health Care

Primary Care Type ED presentations

A collaboration of the School of Primary, Aboriginal and Rural Health Care between the disciplines of General Practice and Emergency Medicine. Prof Yusuf Nagree, A/Prof Alistair Vickery, Dr David Mountain and Dr David Whyatt.

Contact

A/Prof Alistair Vickery
Primary Health Care
Discipline of General Practice
SPARHC, Faculty of Medicine, Dentistry and Health Sciences
University of Western Australia
Ph: +618 9 346 1908
Email:  alistair.vickery@uwa.edu.au

1st Floor, N Block,  QEII Medical Centre, 
Caladenia Crescent (off Monash Avenue roundabout),
Nedlands  WA  6008

Background

Primary care-type emergency department (PCTED) presentations are understood to be ED attendances that could have been managed appropriately in general practice and thus be avoided. However, there is no agreement on how such attendances can be defined. Previous studies have focussed on low urgency triage category presentations in ED and examined administrative datasets.  Triage categories define urgency but do not categorise by severity or complexity. Furthermore, these studies have been undertaken by ED physicians rather than GPs, raising questions around agreement in what a GP-appropriate presentation might be.  Of the 1 million ED presentations per year in WA, 60-70 percent of patients are not admitted to hospital after an emergency presentation. PCTEDs are thought to comprise between 10-25% of all ED presentations in WA.  With appropriate or additional resources many of these patients may have been managed in Primary Care. Furthermore, this lack of an accurate definition for PCTEDs has made measuring the impact of such presentations on ED utilisation difficult.  By better defining the actual burden of PCTED, as determined by primary care physicians and corroborated by ED physicians, this study will be able to identify appropriate interventions and cost-effective programs for further investigation, such that significant reductions in cost can be found. A reduction in PCTED presentations by 10% would save the state $10-20 million per annum.

Aims

  1. To allow both General Practitioners and ED physicians to assess patients presenting to ED, in order to determine which patients could have been diverted or prevented from presenting to ED and managed in primary care. 
  2. To define PCTED presentations, in order to better plan programs or policies that could re-direct or manage PCTED more appropriately in primary care and reduce PCTED presentations. 
  3. To examine the extent of PCTEDs across WA Health.
  4. To determine what additional resources may be required to manage PCTEDs in primary care.
  5. To determine the size and burden of PCTED and the potential savings to the health system if the identified patients had been managed in GP.

Summary

This is a study designed to help better define and identify Primary Care Type Emergency Department (PCTED) presentations utilising Primary Care assessment and ED physicians to determine the burden of such attendances in WA Emergency Departments (ED).  This will help to better design cost-effective programs and policies to target appropriate patients to reduce PCTED presentations and better manage such patients in primary care.
A GP researcher will be placed in selected metropolitan and regional EDs. Patients presenting to ED who are not admitted to hospital will be invited to have an interview with a GP researcher in the form of a normal GP consultation taking up to 15 minutes.  The GP researcher will then determine from this interview whether in the GP’s clinical view that the ED presentation is either:

  1. Not a PCTED presentation
  2. PCTED presentation
  3. PCTED presentation (if additional resources or skills were available)
Additionally, for each patient the treating ED physician will indicate if they believe the patient was a PCTED attendance. This will for the first time provide an indication, from a primary care perspective, of the burden of PCTED presentations and to determine the concordance in such presentations between ED physicians and GPs.  
All consenting patients’ information will be linked to Emergency Department Data Collection data to determine primary diagnosis, ATSI status, presentation rates, and referral to community services. This will be compared to linked de-identified EDDC data for the population of WA across a calendar year. This allow for the determination of the representativeness of the sample and extrapolation of findings across the system to determine the burden of PCTED presentations.

Analysis of the patient diagnoses will be examined to identify themes related to age, diagnosis, lack of resources in primary care, timing, cost and triage categories.  An appropriate definition of PCTED attendance will be identified. Cost-effective primary care interventions required to avoid PCTED presentations will be developed, such as providing alternative services or re-direction policy, cost-effective primary care resources, skill training, or education.
 

School of Primary, Aboriginal and Rural Health Care

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Last updated:
Thursday, 21 January, 2016 5:35 PM

http://www.sparhc.uwa.edu.au/2836810