Self-triage at an urgent care collaboration with and without information campaign

Patients in Belgium needing out-of-hours care have two options: the emergency department (ED) or the general practitioner on call. The latter is often organized in a General Practice Cooperative (GPC). At the ED, there is an overload of patients who could be helped more efficiently by the GPC.

What is the proportion of patients switching from the ED to the GPC (called voluntary switchers) with and without an information campaign? What are the characteristics of these patients?

Single-center prospective intervention trial during the opening hours of the GPC (only weekends: Friday 7.00 pm to Monday 7.00 am). The first 10 weekends there was no intervention. The next 24 weekends, patients in the ED were informed about the out-of-hours care in Belgium. The information contained several topics: characteristics of both services, where to go using examples, practicalities, and costs. This information was distributed through leaflets and broadcasted on a screen in five languages.

During the study period, 7,453 patients entered the ED of which 330 are voluntary switchers. The proportion of voluntary switchers was 1.7 percent before and 5.4 percent after the intervention (p < 0.01). This effect remained stable for 10 more months after the study. The average number of patients presenting at the ED per hour was 3.1, whereas on hours with voluntary switchers was 5.1 (p < 0.01). The age distribution and epidemiological profile of the voluntary switchers resembles the one of primary care patients. The general practicioners (GPs) referred 6 percent of the voluntary switchers back to the ED.

Co-location of the GPC and the ED and informing patients is a meaningful step toward a more profound collaboration.