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Are after-hours patients turning to your ED unnecessarily? Here's how one hospital solved the problem.

January 10, 2019

    Convenient access is a huge priority for patients seeking primary care. In fact, when we asked patients to rank 56 primary care attributes in a 2014 consumer preference survey, six of the top 10 most important ones related to access and convenience. These were things like 24/7 GP access, short wait times, same-day scheduling, and so on.

    How hospitals can work with GPs to transform primary care

    And when primary care isn't so convenient, patients turn to alternatives—often the emergency department (ED). In our most recent international survey, we asked 1,500 consumers in England what drives their use of the ED versus a GP clinic. The third most common response was that their GP was closed after-hours or over the weekend.

    It's a tricky problem that we see in almost every market. Despite hospitals and GPs having different funding streams and business models, hospitals are increasingly on the hook for patients who GPs don't have the capacity—or convenience—to serve.

    But there has been progress. We have seen hospitals and health systems around the improving access at critical points that help both parts of the continuum. One of the more unique solutions comes from CHU de Liège, a university hospital in Belgium with the busiest ED in the country.

    Enhancing GP access, one call at a time

    Liège was struggling with after-hours ED visits. To help, the local GP association launched a GP phone line that patients could call with urgent needs outside of normal office hours. Instead of one GP practice remaining open all night long, several GPs rotated on-call coverage for emergent house calls to respond to patients as necessary.

    But after the GP phone line launched, Liège continued to see a large number of unnecessary ED presentations, many of which were being referred from the phone line. When the hospital investigated, they found that the GPs didn't feel safe doing house calls at night and so were sending even low-acuity patients to the ED. So Liège proposed a solution—the hospital would manage the GP line instead.

    Now, when a patient calls the GP line between 8 p.m. and 8 a.m., the call is diverted to a nurse in Liège's ED who uses an acuity algorithm to triage the call. The nurse either addresses the patient's question over the phone, decides that he or she is indeed emergent and tells him or her to come to the ED, or—more often than not—schedules the patient to the see his or her GP at another time.

    What started with just one group of doctors grew to include multiple practices, and a nearby hospital has partnered with Liège to expand the service. The call line is now available to roughly half a million potential callers, and it receives more than 4,000 calls a year.

    Under Liège's approach, everybody wins

    The results of this triage process are impressive. Half of the calls result in a recommendation to see a GP at another time—most of them are not even urgent enough for a next-day appointment. Only a quarter are truly emergent and need to be patched into Belgium's emergency line.

    The line has successfully reduced inappropriate presentations to the ED at night. The GPs value the line because it greatly reduced the need for evening house calls. And patients love it because they can speak to someone immediately and receive help for their symptoms.

    It also had an unintended—but positive—consequence: In offering this service to GPs, the hospital became a trusted and valued partner among participating practices. Now, GPs more frequently think of Liège as a specialty referral site during the day. This is exactly what many acute providers are looking for—an increase in appropriate specialty referrals and a decrease in costly, unnecessary ED presentations.

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