Cochrane Summaries

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Does employing general practitioners to provide care for patients with non-urgent problems in emergency departments decrease resource use and costs?

Khangura JK, Flodgren G, Perera R, Rowe BH, Shepperd S
Published Online: 
14 November 2012

An important portion of patients who attend hospital emergency departments (EDs) present with health problems that are classified as non-urgent. With many EDs experiencing long-waits and overcrowding, it has been suggested that providing primary care services in EDs for patients with non-urgent problems may be an efficient and cost-effective alternative to emergency care.

This review included three non-randomised studies, involving a total of 11 203 patients, 16 General Practitioners (GPs), and 52 Emergency Physicians (EPs), evaluating the effects of introducing GPs to provide care for patients with non-urgent problems in the ED, compared to EPs. The reported outcomes were similar across studies, however, pooling of the results was not feasible due to differences among the studies. Hence, we present the results as individual study risk ratios (RRs).

Two studies, involving 9325 patients and conducted at urban-teaching hospitals, demonstrated that GPs order less blood tests and x-rays and admit fewer patients to hospital. In addition, these studies demonstrated that EPs referred more patients and prescribed more medications than GPs. These two studies showed marginal cost savings of the intervention and provided limited evidence on patients' self-reported health outcomes.

A third study reported no differences between the two approaches with respect to blood tests, x-rays or hospitalizations. It did show that GPs referred more patients and prescribed more medications than EPs. This study involved fewer participants (1878), and used an unstructured triage system which may have led to misclassification of patients into urgent and non-urgent groups.

None of the included studies provided data on patient wait-times, length of hospital stay, adverse effects or mortality. Overall, the evidence is of very low quality, the safety has not been thoroughly examined and results are disparate. The evidence suggests that there is insufficient basis upon which to draw conclusions regarding the effectiveness and safety of care provided by GPs versus EPs for non-urgent patients in the ED.