General practitioners' assessments of the primary care caseload in Middlemore Hospital Emergency Department

N Z Med J. 2003 Feb 21;116(1169):U329.


Aim: To estimate the proportion of Middlemore Hospital Emergency Department (ED) attendances that GPs thought could be handled in primary care.

Methods: A retrospective review of 300 randomly selected discharge summaries of non-admitted patients by 12 GPs.

Results: Data were available from 278 discharges. Agreement between GP reviewers was "fair" (kappa = 0.34, Kendall's W = 0.48). In 50 cases, the GPs were unanimous that the case was a primary care case (18%). In two cases, there was unanimity that the case was an ED case (<1%). The 12 GPs assessed that an average of 56% (range 38-81%) of the cases they reviewed could have been handled in their surgeries yesterday with no extra resources. This suggests that 34% of the total ED caseload (ie, including admitted patients) could be managed in primary care.

Conclusions: A significant proportion of ED attendances at Middlemore Hospital could be handled in primary care; however, there is considerable variation in GP estimates of this proportion.

MeSH terms

  • Adolescent
  • Adult
  • Case Management / classification
  • Case Management / statistics & numerical data*
  • Child
  • Child, Preschool
  • Family Practice / statistics & numerical data*
  • Female
  • Hospitals, Military / statistics & numerical data
  • Humans
  • Infant
  • Male
  • New Zealand / epidemiology
  • Primary Health Care / statistics & numerical data*
  • Random Allocation
  • Retrospective Studies