Evidence map›Paper›PMID 36127084›Full record

ArticleBMJ open2022

Do general practitioners working in or alongside the emergency department improve clinical outcomes or experience? A mixed-methods study.

Arabella Scantlebury, Joy Adamson, Chris Salisbury, Heather Brant, Helen Anderson, Helen Baxter, Karen Bloor, Sean Cowlishaw, Tim Doran, James Gaughan and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
3.1field-weighted citation impact, top 8% of its field
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 4 institutions in 2 countries.

Arabella ScantleburyYork Trials Unit, University of York Department of Health Sciences, York, UK.ORCID 0000-0003-3518-2740
Joy AdamsonDepartment of Health Sciences, University of York, York, UK.ORCID 0000-0002-9860-0850
Chris SalisburyCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.ORCID 0000-0002-4378-3960
Heather BrantSchool of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK.ORCID 0000-0001-9608-7451
Helen AndersonDepartment of Health Sciences, University of York, York, UK.
Helen BaxterSchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Karen BloorDepartment of Health Sciences, University of York, York, UK.ORCID 0000-0003-4852-9854
Sean CowlishawCentre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Tim DoranDepartment of Health Sciences, University of York, York, UK.
James GaughanDepartment of Health Sciences, University of York, York, UK.ORCID 0000-0002-8409-140X
Andy GibsonSchool of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK.
Nils GutackerCentre for Health Economics, University of York, York, UK.
Heather LeggettDepartment of Health Sciences, University of York, York, UK.ORCID 0000-0001-8708-9842
Sarah PurdySchool of Social and Community Medicine, University of Bristol, Bristol, UK.
Sarah VossSchool of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK.ORCID 0000-0001-5044-5145
Jonathan Richard BengerSchool of Health and Social Wellbeing, College of Health, Science and Society, University of the West of England, Bristol, UK jonathan.benger@uwe.ac.uk.
University of York · GBUniversity of the West of England · GBUniversity of Bristol · GBThe University of Melbourne · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo examine the effect of general practitioners (GPs) working in or alongside the emergency department (GPED) on patient outcomes and experience, and the associated impacts of implementation on the workforce.

designMixed-methods study: interviews with service leaders and NHS managers; in-depth case studies (n=10) and retrospective observational analysis of routinely collected national data. We used normalisation process theory to map our findings to the theory's four main constructs of coherence, cognitive participation, collective action and reflexive monitoring. SETTING AND

participantsData were collected from 64 EDs in England. Case site data included: non-participant observation of 142 clinical encounters; 467 semistructured interviews with policy-makers, service leaders, clinical staff, patients and carers. Retrospective observational analysis used routinely collected Hospital Episode Statistics alongside information on GPED service hours from 40 hospitals for which complete data were available.

resultsThere was disagreement at individual, stakeholder and organisational levels regarding the purpose and potential impact of GPED (coherence). Participants criticised policy development and implementation, and staff engagement was hindered by tensions between ED and GP staff (cognitive participation). Patient 'streaming' processes, staffing and resource constraints influenced whether GPED became embedded in routine practice. Concerns that GPED may increase ED attendance influenced staff views. Our quantitative analysis showed no detectable impact on attendance (collective action). Stakeholders disagreed whether GPED was successful, due to variations in GPED model, site-specific patient mix and governance arrangements. Following statistical adjustment for multiple testing, we found no impact on: ED reattendances within 7 days, patients discharged within 4 hours of arrival, patients leaving the ED without being seen; inpatient admissions; non-urgent ED attendances and 30-day mortality (reflexive monitoring).

conclusionsWe found a high degree of variability between hospital sites, but no overall evidence that GPED increases the efficient operation of EDs or improves clinical outcomes, patient or staff experience. TRIAL REGISTRATION NUMBER: ISCRTN5178022.

Indexed as

General PractitionersEmergency Service, HospitalHospitalizationHumansInpatientsRetrospective Studiesaccident & emergency medicinehealth policyprimary carequalitative research

Identifiers

PMID36127084
PMCPMC9490584
OpenAlexW4296782403

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.