How features of primary care influence self-referral to the Emergency Department: A storyboard

Conference:

SAPC ASM 2016 - Dublin

Talk Code:

P2.42

Presenter:

Emer Brangan

Co-authors:

Emer Brangan, Lesley Wye, Kath Checkland, Helen England, Alyson Huntley, Daniel Lasserson, Richard Morris, Peter Tammes, Chris Salisbury, Lorna Duncan, Sarah Purdy

Author institutions:

University of Bristol, University of Manchester, University of Oxford

Problem

Rising Emergency Department (ED) use is a major concern for the NHS. A proportion of attendances are considered to be ‘inappropriate’, with patients arguably better managed in primary care. This has influenced initiatives in primary care, such as extended access, and raises questions about the association between ED use and the organisation and delivery of care. We conducted a multi-method study that identified and described potentially modifiable features of primary care associated with ED attendance. This research-generated knowledge has potential use to policy makers and practitioners. However, traditional modes of dissemination do not necessarily have high impact, and more novel alternatives present new opportunities for engagement.

Approach

Our multi-method study involved a systematic review and cross-sectional and longitudinal data analysis to identify features of primary care associated with ED use. A detailed ethnography of six practices was then conducted, with 69 hours of observational data recorded and 19 practice staff and 29 patients/carers interviewed. Patients interviewed all had recent ED attendance(s) (<3 months) and were largely self-referred, with the disposal method as discharge with no follow-up or discharge with follow-up from general practitioner.

We collaborated with commissioners, clinicians, researchers and patients to agree which findings were most important to share with different stakeholders. Following this, we commissioned an illustrator to create an animation depicting the journey to the ED, using primarily qualitative data to highlight factors related to the organisation and delivery of primary care that influence patient/carer help seeking behaviour.

Findings

Supported by quotes taken from interviews and observational field notes, this poster gives a pictorial representation of the animation—a ‘storyboard’ that illustrates the experiences of patients/carers, practice reception staff and GPs. The images and text demonstrate some of the complexity of factors that inhibit help seeking from primary care for urgent problems and influence Emergency Department attendance. Conflicts/differences in perspectives are emphasised, for example the receptionist working in a pressured environment trying to meet (inappropriate) demand; the patient with a poorly child trying to find the most direct route to care.

Consequences

Research findings about how the organisation and delivery of primary care might influence ED use have the potential to impact policy and practice and novel modes of dissemination such as animation or graphic novels provide opportunities to extend impact. Our belief is that graphic representation of data can be more ‘digestible’, engaging and provocative. We hope it will help primary care decision makers better understand how various primary care factors interact to influence patient help seeking behaviour.

Submitted by:

Fiona MacKichan

Funding acknowledgement:

The Primary Care Factors Associated with Unscheduled Secondary Care study was funded by the National Institute for Health Research School for Primary Care Research (study number FR6/168)