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Objective - Emergency Departments and General Practitioner co-operatives collaborate increasingly in Urgent Care Collaborations (UCCs) by sharing one combined entrance and joint triage. The aim of this study is to examine the difference between UCCs and providers who operate separately with respect to the efficiency of patient flow. Methods - This study had a cross-sectional observational design comparing three regions with UCC with three regions with usual care. Outcome measures were efficiency of patient flow, defined as a reducing length of stay (LOS), waiting time (WT) and the mean number of handovers. Data were obtained from electronic medical records. Results - LOS (median 34:00 vs. 38:52 min) and WT (median 14:00 vs. 18:43 min) were statistically significantly longer in UCCs compared with usual care. This difference is mainly explained by the prolonged LOS and WT for consulting a General Practitioner. The mean number of interunit handovers was larger in UCCs. Conclusion - The results indicate that, on average, UCCs do not enhance the efficiency of patient flow. The median LOS and WT are longer in UCCs and more handovers occur in UCCs compared with usual care.

Objective: In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in what is called an Urgent Care Collaboration (UCC). In UCCs, GPs and EDs share 1 combined entrance and joint triage. The objective of this study was to determine if GPs treat a larger proportion of out-of-hours patients in the UCC system, and how this relates to patient characteristics.Methods: This observational study compared patients treated within UCCs with patients treated in the usual care setting, that is, GPs and EDs operating separately. Data on the characteristics of the patients, their consultations, and their health problems were derived from electronic medical records. We performed χ2 tests, independent sample t tests, and multiple logistic regression analyses.Results: A significantly higher proportion of patients attended their on-call GP within the UCC system. The proportion of ED patients was 22% smaller in UCCs compared to the usual care setting. Controlled for patient and health problem characteristics the difference remained statistically significant (OR=0.69; CI 0.66–0.72) but there were substantial differences between regions. Especially patients with trauma were treated more by general practitioners. Controlled for case mix, patients in the largest UCC-region were 1.2 times more likely to attend a GP than the reference group.Conclusion: When GPs and EDs collaborate, GPs take a substantially higher proportion of all out-of-hours patients.

ABSTRACT INTRODUCTION In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage. AIM The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately. METHODS This observational study compared UCCs with the usual care setting on costs by performing linear regression analyses. These costs were also combined with two performance indicators: level of patient satisfaction and the length of stay. A non-parametric bootstrap (resampling) method was performed in order to analyze the cost-effect pairs. RESULTS During the study period, 122,061 patients visited EDs and the out-of-hours GP services. Total mean costs per episode were substantially higher in UCCs: ?480 versus ?392 respectively. In this study, two factors that contributed to higher costs in UCCs compared to usual care were identified. First, there was a higher proportion of GP consultations instead of cheaper medical advice for self-care in UCCs. Second, in UCCs there were more often double costs per episode, as more patients were referred to an ED after triage or consulting GP services. The cost-effectiveness analyses show that UCCs were not dominant on cost-effectiveness compared to the usual care setting. DISCUSSION A substitution of, often self-referring, patients from EDs to GP services does not result in lower costs to society, a shorter length of stay or a higher level of patient satisfaction.