Study title

Evaluating effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments. (GPs in EDs)

Principal / Lead Investigator
Co-Investigators
Type of study

Realist evaluation using mixed methods

Who is the study sponsor?

Cardiff University

Summary 

Hospital emergency departments (EDs) are under increasing, sometimes extreme, pressure. Patients are experiencing long hours of waiting to be seen. We have seen media reports of emergency services in crisis. This situation has arisen partly because people attend EDs with problems that GPs could deal with. Finding better ways to assess and treat patients coming to EDs could have a major impact on the experience and care of the millions of people attending EDs and on all NHS services by providing evidence of how best to manage resources.

Many EDs now work closely with GPs in three main ways: 

  • Assessing patients and sending them to a GP clinic next door to the ED;
  • Placing GPs in the ED to make a brief assessment of patients and decide what type of healthcare provider they need to see
  • Placing GPs in the ED as extra staff to provide treatment.           

It is not known how well these arrangements provide care or if they make a difference to how quickly patients receive treatment and referrals for tests and other services. Our study will look at what works, for whom and in what circumstances. 

In this study we will look at: 

  1. What are the different ways of working, how are they are organised and how common are they?
  2. How do they work in practice? Do they do what they were meant to do?
  3. Hospital admissions, re-attendance, waiting times, patient safety and staff and patient satisfaction
  4. What are the key factors that lead to a better service? 
Public / patient involvement

Two public collaborators recruited from the Involving People network were co-applicants for the project funding.  They attended and contributed to all meetings, read and commented on drafts and prepared the lay summary. During the study they will have a key role in planning the stakeholder events and supporting public attendees. 

How could this research potentially benefit patients?

Currently, the effectiveness of each GP-ED model is unclear in terms of its impact on service provision, patient experience and the effectiveness and safety of clinical care delivery. This study plans to address that research gap.

Does the study involve a methodological innovation?

The mixed methods design will use ‘realist evaluation’ to examine the effectiveness of the models in terms of what works, for whom and in what circumstances. 

Funder

Health Services and Delivery Research (HS&DR) Programme       

Total grant value

£ 954,863

Start date

01/03/2017

End date 

29/02/2020

Further info (e.g. related web link)

Response to article: All emergency departments must have GP led triage by October. BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1270 (Published 10 March 2017)

Outputs generated (Reports / Publications / Impact)

To follow