Doeltreffendheid van de huisartsen bij spoedeisende hulp afdelingen

Effectiveness of GPs in accident and emergency departments.
Boeke AJ, van Randwijck-Jacobze ME, de Lange-Klerk EM, Grol SM, Kramer MH, van der Horst HE.
Br J Gen Pract. 2010 Oct;60(579):e378-84.
PMID: 20883612

Veel zelfverwijzers maken onterecht gebruik van de spoedeisende hulpafdelingen.
Doel van dit onderzoek is te bepalen of het inzetten van huisartsen overdag bij spoedeisende hulp en een triage-systeem efficienter is dan de gebruikelijke manier.
Resultaat van dit onderzoek: patiënttevredenheid met de behandeling was aanzienlijk toegenomen. Vergeleken met de gebruikelijke zorg-methode, resulteerde de nieuwe werkwijze in een 13% daling van de aanvullende onderzoeken. Het percentage foute diagnoses (1%), als maatstaf voor de kwaliteit van de zorg, was vergelijkbaar met de twee methoden. De gemiddelde doorlooptijd daalde 93 tot 69 minuten (P <0,001). De gemiddelde behandelduur daalde 60 tot 35 minuten (P <0,001).

BACKGROUND: Many self-attending patients make inappropriate use of accident and emergency departments.

AIM: To determine whether a new care method consisting of the involvement of a GP during the day with the staff of the accident and emergency department of an academic city hospital and application of the Nederlands Triage System by a practice nurse is more effective than usual care.

DESIGN: Before and after intervention design.

SETTING: Accident and emergency department in the VU University Medical Center in Amsterdam.

METHOD: Participants were patients (n = 1527) attending the accident and emergency department without a referral, on weekdays from 10.00-17.00 hours, from 1 November 2006 to 30 April 2007. The intervention consisted of a new care method that combined the involvement of a GP in the accident and emergency department and allocation of patients by triage to either the GP or the accident and emergency department physician. Main outcome measures were patient satisfaction, number and type of additional examinations, quality of diagnosis, process time, and treatment time.

RESULTS: Patient satisfaction with the treatment increased significantly. Compared to the usual care method, this new care method resulted in a 13% decrease in additional examinations. The percentage of incorrect diagnoses (1 %), as a measure of quality of care, was similar with the two methods. The mean process time decreased from 93 to 69 minutes (P<0.001). The mean treatment time decreased from 60 to 35 minutes (P<0.001).

CONCLUSION: The new care method resulted in greater patient satisfaction and maintained the quality of care, with fewer additional examinations. It reduced both the process time and the treatment time.

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