BackgroundIn many countries, Emergency Medical Services (EMS) and General Practitioners (GPs) are confronted with an increasing demand for emergency care and act as gatekeepers of Emergency Department (ED) referrals. EMS make many non-severe and primary care related responses and so we hypothesized that their referrals, being primarily made outside office hours, would be characterized by a higher proportion of non-severe cases than GP referrals, and would less likely lead to hospitalization.MethodsA prospective cross-sectional study including patients aged 65 years and above referred to an ED following a request for EMS assistance, either via GP referral or directly to the EMS. The data were collected over three months within the EDs of three Dutch hospitals. The data are analyzed using IBM SPSS Statistics version 25.ResultsOur results show that EMS professionals were significantly more likely to refer elderly patients aged between 65 and 74 years of age, whereas GP referrals were more often aged between 75 and 84. We found no significant difference in the proportions classified as ‘non-severe’ on arrival in the ED between the EMS or GP referral routes, but the dispatch urgency (p<.001), diagnosis groups (p=.034), and admission rates (p=.025) did differ significantly. Of the referrals initially judged non-severe by the ED physician, i.e., as ‘requiring no hospital admission’, 22.9% of the EMS referrals were admitted against 48.6% of the GP referrals. For those classified as ‘severe’, there were statistically significant differences between the two referral routes in terms of: time of referral (p=0.002), dispatch urgency (p<0.001) and severity level (p=0.017). In the ‘most severe’ groups, differences were identified in: age distribution (p=.018), advanced directive (p=.0037), dispatch urgency (p=0.006), severity level (p=0.041) and length of stay in the ED (p=0.010).ConclusionsThe proportions of ED arrivals classified as ‘non-severe’ did not differ significantly between GP referrals and direct EMS referrals, but the dispatch urgency and diagnosis groups did. Further 35.7% of all ‘non-severe’ cases were hospitalized. ‘Non-severe’ patients referred by a GP were on average significantly older than those referred by the EMS. Whether ED referrals classified as ‘non-severe’ should be considered as inappropriate was not evaluated and warrants further investigation. 

Date: 2018-10-01

Date: 2019-01-16

Date Submitted: 2023-02-06