Primary care in the accident and emergency department: I. Prospective identification of patients

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Abstract
Objective:To compare patient characteristics and consultation activities for attenders at accident and emergency departments assessed by nurse triage as presenting with “primary care” or “accident and emergency” type problems. Design:One year prospective study. Setting:A busy, inner city accident and emergency department in south London. Subjects:Of the 5658 patients treated for new problems during a stratified random sample of 204 three hour sessions between 10 am and 9 pm during June 1989 to May 1990, all “primary care” (2065 patients) and a 10% random sample of “accident and emergency” (291 patients) were included in the analysis. Main outcome measures:Patient's age, sex, duration of presenting problem, diagnosis, laboratory and radiographic investigations, treatments, and referrals. Results:40.9% of attenders with new problems were classified by triage as presenting with “primary care” problems (95% confidence interval 39.6% to 42.2%). Primary care attenders were more likely than accident and emergency patients to be young adults, to have symptoms with a duration of longer than 24 hours, and to present problems not related to injury (all PConclusion:Accident and emergency triage can be developed to identify patients with problems that are more likely to be of a primary care type, and these patients are less likely to receive an investigation, minor surgical procedure, or referral. Many patients in this category, however, receive interventions likely to support their decision to attend accident and emergency rather than general practice. This may reflect limitations in the sensitivity of triage practice or a clinical approach of junior medical staff that includes a propensity to intervene.