The impact of general practitioners working in or alongside emergency departments: a rapid realist review

Cooper, Alison ORCID: https://orcid.org/0000-0001-8660-6721, Davies, Freya ORCID: https://orcid.org/0000-0002-6956-1100, Edwards, Michelle ORCID: https://orcid.org/0000-0001-7432-2828, Anderson, Pippa, Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699, Cooke, Matthew W., Donaldson, Liam, Dale, Jeremy, Evans, Bridie Angela, Hibbert, Peter D., Hughes, Thomas C. ORCID: https://orcid.org/0000-0002-3055-3154, Porter, Alison, Rainer, Tim ORCID: https://orcid.org/0000-0003-3355-3237, Siriwardena, Aloysius, Snooks, Helen and Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 2019. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. BMJ Open 9 (4) , e024501. 10.1136/bmjopen-2018-024501

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Abstract

Objectives Worldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak. Design Rapid realist literature review. Setting Emergency departments. Inclusion criteria Articles describing general practitioners working in or alongside emergency departments. Aim To develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system. Results Ninety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes. Conclusions Multiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made
Publisher:	BMJ Publishing Group
ISSN:	2044-6055
Date of First Compliant Deposit:	16 April 2019
Date of Acceptance:	24 January 2019
Last Modified:	07 May 2023 10:56
URI:	https://orca.cardiff.ac.uk/id/eprint/121808

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