As part of its regular myth-busting series, the Canadian Health Services Research Foundation has examined the oft repeated claim that emergency departments are clogged with patients who should be seeing GPs.
You can read the article in full here – or skip straight to the conclusion that: …”research suggests that simply reducing noses through the ER door and introducing more primary care physicians alone will not resolve the backlog. ER overcrowding is a symptom of a larger set of issues that cannot be addressed by the emergency department – or even hospitals – alone. As a recent report on improving access to emergency care states:
A system wide problem cannot be remedied by selecting only portions of a system wide solution.”
The article introduced me to a term I hadn’t met before: “orphan patients” – those who have no primary care provider and see the hospital emergency department as their only source for medical attention.
One Comment
Doctor Whom
There are a lot of myths around A&E that needs busting and this is one of them. It seems to suit some pollies, economists and bureaucrats to perpetuate the myth that the bulk of presentations at A&E are simple GP cases that should be seen elsewhere – by GP and others.
Many are simple enough cases that could go to a GP or nurse but the reasons they present at A&E are not as straightforward as sometimes made out.
Many people do not have a regular GP. This isn’t just the “orphans” or the homeless or mentally ill. There is increasing presentations of 18 – 30 + year olds who see the A&E as just another health retail outlet alongside the chemist and the local bulk billing clinic or the GP clinic near work. The advantage of A&E is that it is open 24 hours and has all the diagnostics available and consultants on tap.
These GP type consults do not slow down care for urgent matters. Everyone is triaged at A&E so the GP type runny nose just waits longer – until all urgent, semi urgent and really ill people get seen.
Level 4 and 5 patients may only have small % of admissions from their numbers but because they are a large amount of people they can often be one of the
biggest % of the hospital’s total admissions.
Some research on A&E a few years back showed that a great many of the 4 & 5 presentations were people with chronic, not acute, illnesses, but that their management was bad resulting in side effects and symptoms which specialist weren’t available to fix. Some were people with terminal illnesses such as cancer who had inadequate pain management etc. A very large % of these people who presented as 4 &5 at A&E died within 18 – months or two year of presentation. Not because of the presentation but because they were on the last legs of a chronic or terminal illness.
The above would suggest that many of these people are needing better management by specialist teams (oncologist, cancer nurses, etc) and to and extent may be said to be presenting at the right place – A&E where there are sophisticated diagnostic and high level professionals.
There is a surprising amount of hostility toward level 4 & 5 A&E presentation by policy makers. Yet the numbers presenting at A&E continue to increase.
One solution would be to accept the reality and make A&E areas into 24/7 (or 18/7 -in reality not too much presents after 12 am to 7 am) retail health precincts. With A&E, Primary Care /GP clinics, Chemist, Physios, nurses and other primary care practitioners etc all available within an area convenient to patients and professionals with public transport and parking.
Then GPs and other can refer across to higher care levels as needed or refer back community based practitioners the next day.