Hospital-integrated general practice: a promising way to manage walk-in patients in emergency departments

J Eval Clin Pract. 2014 Feb;20(1):20-6. doi: 10.1111/jep.12074. Epub 2013 Aug 28.


Rationale, aims and objectives: The inappropriate use and overcrowding of emergency departments (EDs) by walk-in patients are well-known problems in many countries. The current study aimed to determine whether ambulatory walk-in patients could be treated more efficiently in a new hospital-integrated general practice (HGP) for emergency care services compared to a traditional ED.

Methods: We conducted a pre-post comparison before and after the implementation of a new HGP. Participants were walk-in patients attending the ED of a city hospital in Zurich. Main outcome measures were differences in total process time, time intervals between stages of care and diagnostic resources used.

Results: The median process time from admission to discharge was 120 minutes in the ED [interquartile range (IQR): 80-165] versus 60 minutes in the HGP (IQR: 40-90) (P < 0.001). The adjusted odds ratio of receiving any additional diagnostics was 1.86 (95% confidence interval 1.06-3.27; P = 0.032) for ED doctors versus general practitioners (GPs) when controlling for patients' age, sex and injury-related medical problems.

Conclusion: The HGP is an efficient way to manage walk-in patients with regard to process time and utilization of additional diagnostic resources. The involvement of GPs in the HGPs should be considered as a promising model to overcome the inappropriate use of resources in EDs for walk-in patients who can be treated by ambulatory care.

Keywords: emergency care; implementation; out-of-hours care; primary care; self-referral; walk-in patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care / organization & administration*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • General Practice / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Systems Integration*
  • Time Factors
  • Triage