The vast majority of patients seen in out-of-hours (OOH) general practice and those who are referred to hospital from this setting do not have significantly abnormal physiology, concludes a study published in the Emergency Medicine Journal.
The historical cohort study used routinely collected data from the Birmingham OOH general practice Research Database. This included patients who attended a large OOH provider in the West Midlands between July 2013 and July 2018 for whom National Early Warning Score (NEWS) was not calculated but physiological observations were recorded.
A NEWS was calculated for 74,914 consultations. Almost half (46.9%) of patients had a NEWS of 0, whereas 30.6 per cent had a NEWS of 1.
Patients were referred to hospital in 8.5 per cent of all encounters. Only 6.9 per cent (95% CI, 6.3%-7.5%) of the 6878 patients referred to hospital had a NEWS of ≥5.
Of the 1509 patients with a NEWS ≥5, 68.6 per cent (95% CI, 66.2%-70.9%) were not referred to hospital.
For patients seen in their own homes, there was a clearer relationship between NEWS and referrals. They say this is likely to be due to the fact that the populations are quite different, with home visit patients being considerably older (by 37 years) with less physiological reserve and more complex medical needs.
The authors concluded that, in the setting of primary care, NEWS does not align consistently with referral decisions. The comment that this misalignment is likely to be influenced by a variety of factors including limited (or no) access to patient records and investigations, a lack of alternative care pathways and poor OOH social and health care support.
At the same time, a decision not to refer could be because the patient’s problem can be managed in the community, they said.