Evaluating effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments (GPs in EDs)

PROJECT TITLE EVALUATING EFFECTIVENESS, SAFETY, PATIENT EXPERIENCE AND SYSTEM IMPLICATIONS OF DIFFERENT MODELS OF USING GPS IN OR ALONGSIDE EMERGENCY DEPARTMENTS (GPS IN EDS)
Funding body National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme
Total funding  £954,863
Team
Team/consortium
  • Cardiff University
  • Swansea University
  • University of Northumbria
  • Macquarie University, Australia
  • Oxford School of Emergency Medicine
  • University of Lincoln
Overarching aim Our aim is to evaluate using realist methods the effectiveness, safety, patient experience and system implications of different models of using GPs in or alongside Emergency Departments understanding the effects and the mechanisms by which they are brought about in different contexts.
Objectives
  • In this study we investigated GPs working in Emergency Departments to ascertain:
  • What are the different ways of working, how are they are organised and how common are they?
  • How do they work in practice? Do they do what they were meant to do?
  • Hospital admissions, re-attendance, waiting times, patient safety and staff and patient satisfaction
  • What are the key factors that lead to a better service?
Methods Realist evaluation using mixed methods
Outcomes Effectiveness of GPs in ED models in terms of what works, for whom and in what circumstances.
Outputs Peer reviewed publications, conference presentations and recommendations for services.

Peer reviewed publications: 

Cooper A, Carson-Stevens A, Edwards M, Davies F, Donaldson L, Anderson P, Cooke M, Dale J, Evans B, Harrington B, Hepburn J, Hibbert P, Hughes T, Porter A, Siriwardena AN, Snooks H, Edwards A (2021). Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation. British Journal of General Practice (in press)

Edwards M, Cooper A, Hughes T, Davies F, Sherlock R, Anderson P, Evans B, Carson-Stevens A, Cooke M, Dale J, Hibbert P, Harrington B, Hepburn J, Porter A, Rainer T, Siriwardena AN, Snooks H, Edwards. A classification of primary care streaming pathways in UK emergency departments: findings from a multi-methods study comprising cross-sectional survey; site visits with observations, semi-structured and informal interviews. International Emergency Nursing 2021; 56.

Choudhry M, Edwards M, Cooper A, Anderson P, Carson-Stevens, A, Cooke M, Dale J, Hibbert P, Hughes T, Porter A, Rainer T, Siriwardena AN, Edwards A. Senior clinical and business managers’ perspectives on the influence of different funding mechanisms, and barriers and enablers to implementing models of employing General Practitioners in or alongside Emergency Departments: qualitative study. Health Policy 2021; 125(4):482-488.

Price D, Edwards M, Carson-Stevens A, Cooper A, Davies F, Evans B, Hibbert P, Hughes T, Rainer T, Siriwardena AN, Edwards A. Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences. BMC Medical Research Methodology 2020 20:151.

Cooper A, Davies F, Edwards M, Anderson P, Carson-Stevens A,Cooke M, Donaldson L, Dale J, Evans B, Hibbert P, Hughes T, Porter A, Rainer T, Siriwardena AN, Snooks H, Edwards A. The impact of general practitioners working in or alongside emergency departments: a rapid realist review. BMJ Open 2019 2019;9:e024501.

Cooper A, Edwards M, Brandling J, Carson-Stevens A, Cooke M, Davies F, Hughes T Morton K, Siriwardena AN Voss S, Benger J, Edwards A. A taxonomy of the form and function of primary care services in or alongside emergency departments: concepts paper. EMJ 2019; 36: 625-630.

Cooper A, Carson-Stevens A, Hughes T Edwards A. Is streaming patients in emergency departments to primary care services effective and safe? BMJ 2020;368:m462

Conference presentations and abstracts:

Primary care streaming in emergency departments and perceived mechanisms for effectiveness. SWSAPC, 2020.

Senior clinical and business managers’ perspectives on how different funding mechanisms and models of employing GPs in or alongside EDs influence wider system outcomes. Qualitative Study. SWSAPC, 2020.

A classification of primary care pathways in EDs: a multi-method study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Patients’ motivations and expectations when seeking urgent care at emergency departments and acceptability of primary care streaming: a realist study (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

Primary care streaming in emergency departments – contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation (oral presentation). RCEM Virtual Scientific Conference, 13-14 October 2020.

The role of GPs working in or alongside emergency departments and how this influences clinical decision-making: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Exploring opportunities to improve patient safety where GPs work in or alongside emergency departments: a realist synthesis and evaluation (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Challenges of recruiting emergency department patients to a qualitative study: a thematic analysis of researchers’ experiences (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Embedding public involvement in a realist evaluation of GPs in Emergency Departments (poster). RCEM Virtual Scientific Conference, 13-14 October 2020.

Impact This study has provideed new information on GP-ED models in terms of impact on service provision, patient experience, effectiveness and safety of clinical care delivery.

 

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