Primary care access to radiology: Characteristics of trauma patients referred to the emergency department

Abstract

Rationale, aims and objectives: Low-urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways.

Methods: Single-centre retrospective observational study of trauma patients referred to the ED by the radiology department during office hours (January 2017-December 2017). Data were obtained from patient records. Descriptive statistics were used to analyse the extracted data.

Results: A total of 662 patients were included. The median age was 42 years (range: 1-100, interquartile range (IQR): 15-63) and patients presented to the ED with a median delay of 1 day (range: 0-112 days, IQR: 0-5). Most patients were referred for injuries involving the upper extremities (61.5%) and lower extremities (30%). A total of 48 additional diagnoses were made in the ED. The majority of injuries was classified as 'minor' (29.5%) or 'moderate' (68.3%) on the Abbreviated Injury Scale (AIS). The median length of stay in the ED was 65 min (range: 7-297 min, IQR: 43-102).

Conclusion: Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.

Keywords: Emergency Department; access to care; primary health care; radiology; trauma.

Figure 1

Injury characteristics (multiple diagnoses possible per patient; a total of 710 ED diagnoses in 662 patients). Left: number of diagnoses within ISS body regions (with % of total diagnoses) and median AIS. Right: most common diagnoses (in % of total diagnoses) within accompanying ISS body region on the left. AIS, Abbreviated Injury Score; ISS, Injury Severity Score.

Figure 2

ED timeline. From left to right: patients are referred to the ED from the radiology department, where they are treated for their injuries (listed in % of patients who received this specific treatment) with a subsequent discharge home or hospital admittance. Median ED waiting time, treatment time and LOS are depicted below the timeline. ED, Emergency Department; IQR, interquartile range.

Figure 3

ED work‐up in patients with additional diagnoses. Forty‐eight extra diagnoses were made in the ED (A), leading to 10 additional treatments (B). ED, Emergency Department.