ReviewBMJ open2019
The impact of general practitioners working in or alongside emergency departments: a rapid realist review.
Review in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed.
- Economic evaluation of diverting low-risk patients from the emergency department to adjacent out-of-hours primary care in Belgium.Primary health care research & development · 2026Trial
- Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial.PloS one · 2021Trial
- Fast-track and primary care in the emergency department: managing more, but not decongesting.Internal and emergency medicine · 2026Observational
- Article
- Mapping same day, urgent and emergency care services across the UK: a mixed methods study protocol.BMJ open · 2026Article
- General Practice-led urgent care practice vs. emergency room - satisfaction of ambulatory patients with low urgency medical problems.The European journal of general practice · 2025Observational
- Patients' perceptions on reasons for self-referring to the emergency department shortly before a cancer diagnosis: a qualitative study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Non-urgent patients in emergency centres in Western Cape district health services.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2025Article
- How are fast tracks organized in adult and pediatric emergency departments in Switzerland? A cross-sectional survey.BMC health services research · 2025Article
- A rapid realist review of literature examining Co-production in mental health services for youth.JCPP advances · 2024Article
- Redirection of low-acuity emergency department patients to nearby medical clinics using an electronic medical support system: effects on emergency department performance indicators.BMC emergency medicine · 2024Observational
- [Redirection of patients from the emergency department to ambulatory care: a feasibility study].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2024Article
- Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation.Emergency medicine journal : EMJ · 2024Article
- What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study.Emergency medicine journal : EMJ · 2023Article
- Exploring Primary Care Streaming Pathway in Emergency Departments in Saudi Arabia: A Qualitative Study.Emergency medicine international · 2023Article
- Structured evaluation of a virtual emergency department triage model of care: A study protocol.Emergency medicine Australasia : EMA · 2022Article
- Implementing public involvement throughout the research process-Experience and learning from the GPs in EDs study.Health expectations : an international journal of public participation in health care and health policy · 2022Article
- Article
- Realist analysis of whether emergency departments with primary care services generate 'provider-induced demand'.BMC emergency medicine · 2022Article
- Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department.BMC emergency medicine · 2022Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
objectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%-43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are 'free to care for the sickest patients'. However, the research evidence to support this initiative is weak.
designRapid realist literature review.
settingEmergency departments. INCLUSION CRITERIA: Articles describing general practitioners working in or alongside emergency departments.
aimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.
resultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.
conclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research. PROSPERO REGISTRATION NUMBER: CRD42017069741.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.