ATTENDANCE AT ACCIDENT AND EMERGENCY DEPARTMENTS - UNNECESSARY OR INAPPROPRIATE

The proportion of attenders at accident and emergency (A&E) department s who present 'inappropriately' with conditions which could be managed in general practice has been estimated at between 6.7 per cent and 64 -89 per cent. These estimates have been based on subjective assessment s by clinicians, or on an objective classification developed by the Nu ffield Provincial Hospitals Trust (NPHT). This study sought to validat e this classification, and to develop and validate other objective sys tems of classifying A&E attenders. Two novel methods were devised, one based on the ICD-9 diagnosis and one primarily on processes of care. All three techniques were validated against the pooled opinions of a s ample of general practitioners (GPs). The existing NPHT classification was found to be very unreliable. The new diagnostic method was more s pecific but had poor sensitivity, whereas the technique based on proce sses of care agreed remarkably well with the sample of GPs. This metho d was applied retrospectively to random samples of 8877 adult self-ref errals to 16 English A&E departments, and yielded an estimate that 23 per cent could have been treated in general practice. This approach pr ovides a simple and valid retrospective method for identifying patient s who were suitable for care in general practice. The method may be us ed to identify groups of patients who frequently attend inappropriatel y, to identify areas in which primary care needs are not being effecti vely met in general practice, and to form a basis for planning and aud iting strategies to meet those needs in a more appropriate setting.