Impact on an accident and emergency department of Glasgow's new primary care emergency service

Abstract

Objective: To determine the impact, in terms of new attendance figures and types of patients attending, on a city centre accident and emergency (A & E) department following the establishment of out-of-hours primary care emergency centres (PCECs) in Glasgow.

Methods: A questionnaire survey of A&E patients attending out-of-hours at Glasgow Royal Infirmary A&E department, a city centre department with approximately 68,000 new annual attendances, one week before (Group A), twelve weeks after (Group B) and one year after (Group C) the introduction of PCECs. Main outcome measures were attendance numbers within working hours and out-of-hours, reason for A&E attendance, duration of presenting condition, whether primary care services were contacted and awareness of the new primary care emergency centres.

Results: In respect of out-of-hours attendances, 612 questionnaires were completed for group A, 715 for group B and 645 for group C. There was no significant difference in the type of presenting complaints between the groups, i.e. illness or injury. The majority of patients presented within 24 hours of the onset of their condition (82%, 79% and 80% of patients in groups A, B and C respectively). There was a reduction in those attending with conditions of more than one week's duration (8% in group A, 7% in group B and 5% in group C). There was a decrease in the number of patients who considered their problem to be non-urgent (27% in group A, 22% in group B and 16% in group C). Prior to the introduction of the PCEC service 18% of patients (108) had contacted their GP before attending, compared with only 9% (63) of group B and 9% (57) of group C patients. Of these patients there was a significant decrease in the number of patients attending following GP referral. Of the patients who had not contacted the primary care services only 35% (201) knew of the introduction of PCECs 12 weeks later, increasing to 52% (291) after one year (p < 0.01). Significance calculations were performed using a Difference of Proportion Test with a 99% significance level.

Conclusions: Our results suggest that the new PCEC service has not had a significant impact on the number or type of patients attending this A&E department, with fewer self-referred patients contacting primary care services after its introduction. Following the introduction of the PCECs there was a trend towards more patients attending A&E following telephone advice although amongst self-referred A&E patients there remained a large proportion who claimed to be unaware of the new service 12 weeks after, and one year after, the introduction of PCECs. Continued evaluation of the effect on A&E of the new centres will be required to plan future resources for the provision of emergency care.