一般診療ジャーナル

A Qualitative Study on the Variables Affecting the Flow of Patients to General Practitioners in Emergency Rooms

Abstract

Heather Brant

Objective Clinicians, policymakers, and patients are all concerned about the substantial increase in emergency hospital admissions that has occurred in England and Wales in recent years. However, nothing is known about the elements that affected this choice. We sought to determine the potential impact of non-clinical variables on hospital admission rates. Method 21 participants from three acute hospital trusts participated in semi structured interviews with us. 11 emergency department (ED) doctors, 3 ED nurses, 3 supervisors, and 4 inpatient doctors were among the participants. These roles covered a wide range of seniority. The authors established a theoretical framework to explain admission decision-making, and important aspects from that framework served as the basis for interview questions. Two separate researchers used framework analysis to record, transcribe, and analyse the interviews. Findings Non-clinical influences on the choice to admit as opposed to discharge patients were identified as departmental elements like workload, time of day, and levels of senior assistance. Although generally viewed as favourable, the 4-hour waiting time target was criticised for influencing patient admission decisions regardless of clinical need. External factors including a patient's social support network and community follow-up were widely acknowledged as having a significant impact on admission. Finally, it was stated that the ED culture had a significant influence (either positively or adversely) on the choice to admit patients.