Predicting clinical deterioration after initial assessment in out-of-hours primary care: a retrospective service evaluation

Background Accurate assessment of the need for admission is challenging in Out of Hours (OOH) primary care. Understanding more about patient contacts where the decision to continue care in the community may have been incorrect could assist clinicians in assessing clinical risk. Aim To define the population contacting OOH primary care who are at higher risk of re-presenting to this service and requiring urgent transfer to secondary care within three days of their initial contact. Design and Setting Retrospective service evaluation of four years of patient contacts with Oxfordshire OOH primary care. Method Multivariable logistic regression was used to evaluate demographic and service delivery factors associated with increased risk of delayed escalation to secondary care Results Almost 1% of 496 931 patients contacting OOH primary care required escalation to secondary care within 3 days. Of these, 68.5% were initially discharged with no follow-up or advice to contact their GP; 14.7% were initially referred to secondary care. The odds of requiring escalation were increased with age (OR 1.010, 95% CI = 1.009 to 1.011, P Conclusion Older, prior users of the service, presenting at less busy times, are at greater risk of requiring secondary care referral from the OOH service within three days of their initial contact. These higher risk patient groups might benefit from active follow up by the OOH service.