GPs 'could manage most A&E patients'

At least half of the patients who go to often-overcrowded hospital emergency departments could be managed by general practitioners, research indicates.

A study found that half of a random sample of 180 patients from Wellington Hospital's emergency department could have been managed in a standard general practice.

The proportion rose to 68 per cent if laboratory and diagnostic facilities such as x-rays were readily available to a general practice.

The study comes as Waitemata District Health Board officials assess whether to have an accident and medical clinic, at which most patients would pay part-charges, in Waitakere Hospital's emergency department.

An inference from the study - presented at the College of GPs conference in Auckland at the weekend - is that overcrowding of emergency departments could be eased if patients could be handled in primary care. But some physicians resist this notion.

The clinical director of Auckland City Hospital's emergency department, Dr Tim Parke, noted that the study looked at cases retrospectively, by which time the outcome was clear.

Few were done "at the front door" when the course of an illness and its seriousness were often uncertain.

"An example of a condition that can seem very benign in retrospect but can be very difficult is headache. For a fair percentage ... it's a simple tension headache or viral illness and they will be fine, whereas a proportion will have a brain tumour, sub-arachnoid haemorrhage or head injury."

Dr Parke said the main causes of overcrowding were the reliance on trainees rather than senior staff at the entrance to the department and the hospital's wards often being full.

In the study, a panel of 12 GPs, nurses and emergency physicians were asked to assess the 180 patients' case notes.

The researchers noted that there was only "moderate agreement" between panel members and between the different professional groups over which cases were and were not appropriate for primary care.

This reflects a Christchurch Hospital study, published in the Medical Journal in April, which found that health workers disagreed about what defines "appropriate attendance" at an emergency department.

"Without a core definition," say the authors, "it is hard to say what contribution 'inappropriate attenders' make to the problem of overcrowding."