Predictors of emergency department referral in patients using out-of-hours primary care services

Abstract

Background: Out of hours (OOH) doctors could manage many cases limiting the inappropriate accesses to ED. However the possible determinants of referral to ED by OOH doctors are poorly studied. We aimed to characterize patients referred from the OOH to ED service in order to explore the gate-keeping role of OOH service for hospital emergency care and to facilitate future research in improving its cost-effectiveness.

Methods: A retrospective study was made through data collection of 5217 contacts in a local OOH service in the North-East of Italy (from 10/01/2012 to 03/31/2013).

Results: Only 8.7% (=454 people) of the total contacts were referred to ED. In the multivariate analysis, the significant predictors of being sent to ED were: age; residence in nursing home (odds ratios (OR)=2.00, 95%CI: 1.30-3.10); being visited by a OOH physician (OR=2.64, 95%CI: 2.09-3.34). Taking infections as reference, cardiovascular diseases (OR=18.31, 95%CI: 12.01-27.90), traumas (OR=8.75, 95%CI: 5.36-14.26) and gastrointestinal conditions (OR=7.69, 95%CI: 4.70-11.91) increased the probability to be referred to ED.

Conclusions: OOH service addresses several common medical conditions in community-dwelling and in nursing home context, supporting its filtering function for the ED access. The main reasons of ED access could be a crucial aspect in general population education in order to avoid the overcrowding of the ED.

Keywords: Emergency department; Gate-keeping; Out-of-hours primary care.