GP cooperative and emergency department: an exploration of patient flows

J Eval Clin Pract. 2013 Apr;19(2):243-9. doi: 10.1111/j.1365-2753.2011.01806.x. Epub 2012 Feb 5.


Rationale, aims and objectives: In most countries, different health care providers are involved in emergency care. In the Netherlands, out-of-hours care is provided by general practitioner cooperatives (GPCs) and emergency departments (EDs). Our aim was to describe the flow of patients attending emergency care in these settings.

Method: A retrospective record review was performed, concerning patients who had visited a GPC or ED. Recorded information included urgency, diagnostic tests, and follow-up contacts. Descriptive figures were determined for patient flows in GPC and ED for urgent contacts and non-urgent contacts.

Results: We included 319 GPC contacts and 356 ED contacts, of which 78% were non-urgent. The majority of GPC contacts were completed at the GPC without follow-up; 37% of non-urgent patients had a follow-up contact, usually with primary care. Only 5% of non-urgent GPC patients received diagnostic tests compared to 63% of non-urgent ED patients (mostly X-rays). The majority of non-urgent ED patients (88%) had a follow-up contact, usually at an outpatient clinic (67%). Most non-urgent ED patients (83%) who received a diagnostic test also had an outpatient clinic follow-up contact. Of urgent ED patients, the majority had a follow-up contact (85%), mostly with an outpatient clinic (74%).

Conclusion: Although most out-of-hours care patients present non-urgent health problems, at the ED they are more likely to receive diagnostic tests and follow-up contacts. This may reflect differences in patient populations between the ED and GPC or suggest opportunities for improving efficiency of planning follow-up contacts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • After-Hours Care / organization & administration
  • Cooperative Behavior*
  • Emergencies / epidemiology
  • Emergency Service, Hospital* / statistics & numerical data
  • Female
  • General Practice* / statistics & numerical data
  • Humans
  • Male
  • Medical Audit
  • Middle Aged
  • Netherlands
  • Patient Transfer* / statistics & numerical data
  • Retrospective Studies