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

James Gaughan; Dan Liu; Nils Gutacker; Karen Bloor; Tim Doran; Jonathan Richard Benger

doi:10.1136/bmjopen-2021-055976

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

James Gaughan, Dan Liu, Nils Gutacker, Karen Bloor, Tim Doran, Jonathan Richard Benger

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Article number	e055976
Number of pages	7
Journal	BMJ Open
Volume	12
Issue number	2
DOIs	https://doi.org/10.1136/bmjopen-2021-055976
Publication status	Published - 23 Feb 2022

Bibliographical note

Keywords

Emergency Service, Hospital
General Practitioners
Hospitals
Humans
Retrospective Studies
State Medicine

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Cite this

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title = "Does the presence of general practitioners in emergency departments affect quality and safety in English NHS hospitals?: A retrospective observational study",

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.",

keywords = "Emergency Service, Hospital, General Practitioners, Hospitals, Humans, Retrospective Studies, State Medicine",

author = "James Gaughan and Dan Liu and Nils Gutacker and Karen Bloor and Tim Doran and Benger, {Jonathan Richard}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.",

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N2 - 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.

AB - 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.

KW - Emergency Service, Hospital

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