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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Impact of a well-developed primary care system on the length of stay in emergency departments in the Netherlands: a multicenter study

Authors: Wendy A. M. H. Thijssen, Nicole Kraaijvanger, Dennis G. Barten, Marleen L. M. Boerma, Paul Giesen, Michel Wensing

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

The Netherlands has a well-developed primary care system, which increasingly collaborates with hospital emergency departments (EDs). In this setting, insight into crowding in EDs is limited. This study explored links between patients’ ED Length of Stay (LOS) and their care pathways.

Methods

Observational multicenter study of 7000 ED patient records from 1 February 2013. Seven EDs spread over the Netherlands, representing overall Dutch EDs, were included. This included three EDs with and four EDs without an integrated primary-care-physician (PCP) cooperative, forming one Emergency Care Access Point (ECAP). The main outcome was LOS of patients comparing different care pathways (origin and destination of ED attenders).

Results

The median LOS of ED attenders was 130.0 min (IQR 79.0–140.0), which increased with patients’ age. Random coefficient regression analysis showed that LOS for patients referred by medical professionals was 32.9 min longer compared to self-referred patients (95 % CI 27.7–38.2 min). LOS for patients admitted to hospital was 41.2 min longer compared to patients followed-up at the outpatient clinic (95 % CI 35.3–46.6 min), 49.9 min longer compared to patients followed-up at the PCP (95 % CI 41.5–58.3 min) and 44.6 min longer compared to patients who did not receive follow-up (95 % CI 38.3–51.0 min). There was no difference in LOS between hospitals with or without an ECAP.

Conclusions

With 130 min, the median LOS in Dutch EDs is relatively short, comparing to other Western countries, which ranges from 176 to 480 min. Although integration of EDs with out-of-hours primary care was not related to LOS, the strong primary care system probably contributed to the overall short LOS of ED patients in the Netherlands.
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Metadata
Title
Impact of a well-developed primary care system on the length of stay in emergency departments in the Netherlands: a multicenter study
Authors
Wendy A. M. H. Thijssen
Nicole Kraaijvanger
Dennis G. Barten
Marleen L. M. Boerma
Paul Giesen
Michel Wensing
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1400-z

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