Primary care patients in the emergency department: Who are they? A review of the definition of the 'primary care patient' in the emergency department

• Published in: Emergency medicine Australasia 2005-10, Vol.17 (5-6), p.472-479
• Main Authors: Bezzina, Andrew J, Smith, Peter B, Cromwell, David, Eagar, Kathy
• Format: Article
• Language: English
• Subjects: Acute Disease; Australia; Canada; emergency department; Emergency Service, Hospital - organization & administration; Europe; Family Practice; Humans; inappropriate patient; Patient Acceptance of Health Care; Patient Admission; primary care; Primary Health Care - organization & administration; Research Design; Terminology as Topic; Triage - methods; United States
• ISSN: 1742-6731; 1742-6723
• DOI: 10.1111/j.1742-6723.2005.00779.x

Objective:  To review the definition of ‘primary care’ and ‘inappropriate’ patients in ED and develop a generally acceptable working definition of a ‘primary care’ presentation in ED. Method:  A Medline review of articles on primary care in ED and the definitions used. Results:  A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential ‘primary care’, ‘general practice’, or ‘inappropriate’ patients in ED. A representative definition was developed premised on the common factors in these papers: •  Low urgency/acuity – triage categories four or five in the Australasian Triage Scale •  Self‐referred – by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on •  Presenting for a new episode of care (i.e. not a planned return because planned returns are not self‐referred) •  Unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted Discussion:  This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings.