Patient-reported factors associated with emergency department referrals from a co-located out-of-hours walk-in clinic in Germany: a cross-sectional observational study.

Abstract

Objectives: The aim of this study was to identify patient-reported factors associated with the likelihood of emergency department (ED) referral following treatment at a co-located out-of-hours (OOH) walk-in clinic.

Design: Monocentric cross-sectional observational study.

Setting: An OOH walk-in clinic co-located with the ED of the University Medical Center Hamburg-Eppendorf, Germany. The study period was from November 2019 to February 2020.

Participants: A total of 3708 patients attended the walk-in clinic during the study period, with 2574 patients (69.4%) participating in the study.

Main outcome measures: We used logistic regression analysis to calculate adjusted OR (aORs) for patient-reported factors influencing ED referral. The factors examined included reasons for encounter (RFEs), medical history and treatment urgency, categorised according to the International Classification of Primary Care, second edition. Secondary outcomes include descriptive measures of RFE distribution within the study cohort.

Results: The mean age of participants was 40 years (±15.8), and 54.5% were women. The ED referral rate was 15.2% (n=392). Patient-reported factors that increased the likelihood of ED referral included trauma (aOR 2.61; 95% CI: 1.24 to 5.50), eye symptoms (aOR 2.67; 95% CI: 1.48 to 4.83), abdominal pain (aOR 2.51; 95% CI: 1.74 to 3.64), history of type 2 diabetes (aOR 2.24; 95% CI: 1.18 to 4.25), neurological symptoms (aOR 2.18; 95% CI: 1.24 to 3.84) and higher self-perceived urgency (aOR 1.46; 95% CI: 1.12 to 1.89). Factors that decreased the likelihood of ED referral included respiratory symptoms (aOR 0.58; 95% CI: 0.36 to 0.93), neck/back symptoms (aOR 0.52; 95% CI: 0.31 to 0.88), urinary tract symptoms (aOR 0.18; 95% CI: 0.06 to 0.57) and a duration of the health problem >4 days (aOR 0.72; 95% CI: 0.55 to 0.95).

Conclusions: 10 patient-reported factors of ED referrals were identified. Collecting this information during patient registration may enhance resource utilisation and streamline patient flow between walk-in clinic and adjacent ED. These findings could support the development of triage tools for patients in OOH care.