After hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments

Objective: To model the effectiveness of after hours general practice (GP) in reducing metropolitan Perth emergency departments' (ED) low acuity patient (LAP) attendances and costs. Methods: We estimated LAP attendances by comparison of the product of (A) the difference between self-referred and GP-referred ED discharge rates and (B) total self-referred attendances (LAP attendances =A x B). We then compared after hours ED LAP attendance rates and costs with inner metropolitan "working-week" ED LAP attendance rates and costs, when GP services are maximally available. Results: Working-week LAP attendances comprised 8.2% (95% CI, 8.0%-8.4%) of inner metropolitan ED attendances. Excess weekend and evening LAP attendances were estimated to comprise 16.5% (95%CI, 15.9%-17.0%) and 4.5% (95%CI, 4.1%-4.9%) of outer and inner metropolitan ED attendances respectively and totalled less than 3.0% of ED costs. Conclusions: Low acuity patients form a relatively constant, inexpensive proportion of ED workloads. After hours GP LAP services are unlikely to significantly reduce ED attendances or costs. (author abstract)