Putting patient safety first in the planning of GPs working in emergency departments

11 June 2021

The way in which patients are seen and treated in emergency departments has changed over recent years in England. One way in which providers have sought to improve the system is by placing GPs within or alongside emergency departments to address increasing demand.

However, there has been little research carried out to date to look out how safe this is for patients. The issue of patient safety has been highlighted recently by the World Health Organisation as a serious global health concern.

As a key area of research for PRIME Centre Wales led by Cardiff University, researchers Dr Alison Cooper and colleagues investigated the safety of different ways of GPs working in or alongside emergency departments.

The team spent time at different hospitals, observing how patients were seen and treated, and interviewing members of the staff and clinical directors. The majority of clinical directors did not have any patient safety concerns around placing GPs in or alongside emergency departments, however key areas were perceived to facilitate safe patient care: experienced streaming nurses using early warning scores and local guidance to ensure appropriate patients were directed to the GP service; clear governance processes to support GPs’ clinical decision-making and intended role; compatible computer systems and strong clinical leadership to encourage communication and teamwork between services. 

Dr Alison Cooper, lead author of the study and GP Clinical Research Fellow based at PRIME Centre Wales, Cardiff University comments:

“As new healthcare services are introduced into an already complex care delivery setting, it is essential to understand how and why unintended consequences may occur and how these may be mitigated.” 

The team hope the research findings will help inform and guide health care planners and commissioning groups in how to best organise emergency department care and minimise the risk to patient safety.

The research is published in BMJ Open, and can be viewed early access at: https://doi.org/10.3399/BJGP.2021.0090

Paper citation: Alison Cooper, Andrew Carson-Stevens, Michelle Edwards, Freya Davies, Liam Donaldson, Pippa Anderson, Matthew Cooke, Jeremy Dale, Bridie Angela Evans, Barbara Harrington, Julie Hepburn, Peter Hibbert, Thomas Hughes, Alison Porter, Aloysius Niroshan Siriwardena, Helen Snooks, Adrian Edwards. Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation. British Journal of General Practice 27 May 2021; BJGP.2021.0090. DOI: 10.3399/BJGP.2021.0090

Further information about the GPs in EDs project can be found here.