General Practice-led urgent care practice vs. emergency room – satisfaction of ambulatory patients with low urgency medical problems

Emergency room (ER) utilisation by ambulatory patients with low urgency medical problems leads to ER-capacity use and long waiting times. Establishing General Practice (GP)-led urgent care practices (UCP) adjacent to ERs allows to triage patients from the ER to the UCP. However, patients may perceive themselves as ER-cases and expect ER-treatment including extensive diagnostics. To assess UCP-patients’ satisfaction compared to ambulatory ER-patients. Sub-analysis (11/2019–01/2020) of a prospective, monocentric observational study at the University Medical Centre Hamburg-Eppendorf ER and co-located UCP focusing on patient survey data including demographics, waiting time and diagnoses. Satisfaction, uncertainty and appropriateness of waiting time was assessed with 4-point Likert-scales. Analysing 1196 UCP- and 597 ER-patients, patient satisfaction correlated positively with perceived appropriate waiting time in both groups. But more UCP-patients deemed their waiting time appropriate (76.7% vs. 70.4%; <i>p</i> = 0.004) and reported to be very satisfied with the treatment (64.7% vs. 55.8%; <i>p</i> &lt; 0.001). Time until the first physician contact was nearly equal, but the entire length of stay was shorter in the UCP (104 ± 88.0 min vs. 179 ± 301 min; <i>p</i> &lt; 0.001). In both groups, satisfaction was reduced by on-going uncertainty after the visit, but uncertainty was higher among UCP-patients (32% vs. 25%; <i>p</i> = 0.003). Age, gender or diagnosis had no influence on patients’ satisfaction. More UCP-patients stated that today’s problem could have been treated by a GP (57% vs. 15%; <i>p</i> &lt; 0.001) and were advised to follow up in an outpatient setting. Treating patients in an UCP does not lead to overall dissatisfaction. Emergency room (ER)- and urgent care practice (UCP)-patients’ satisfaction correlated positively with a perceived appropriate waiting time, but more UCP-patients stated that their waiting time was appropriate. Satisfaction correlated negatively with on-going uncertainty after the visit; uncertainty was higher among UCP-patients. Age, gender or diagnosis had no influence on patients’ satisfaction.

因低急症程度医疗问题就诊的门诊患者占用急诊室（ER）资源，导致急诊室承载压力过大并出现过长等待时长。在急诊室周边设立由全科医疗（GP）主导的急诊诊疗机构（UCP），可实现将患者从急诊室分诊至该急诊诊疗机构。但部分患者可能自认为属于急诊病例，并期望获得急诊级别的诊疗服务，包括全面的检查项目。本研究旨在对比急诊诊疗机构患者与急诊室门诊患者的满意度。本研究对汉堡-埃彭多夫大学医学中心急诊室及其毗邻急诊诊疗机构开展的一项前瞻性单中心观察性研究进行亚组分析（分析时段为2019年11月至2020年1月），分析数据涵盖患者问卷信息、人口统计学特征、等待时长与诊断结果。采用4级李克特量表评估患者的满意度、就诊疑虑程度及对等待时长的合理性感知。本次分析共纳入1196名急诊诊疗机构患者与597名急诊室患者，两组患者的满意度均与感知到的合理等待时长呈正相关。但更多急诊诊疗机构患者认为其等待时长合理（76.7% vs. 70.4%；<i>p</i> = 0.004），且表示对本次诊疗服务非常满意（64.7% vs. 55.8%；<i>p</i> &lt; 0.001）。两组患者首次接触医师的时长近乎一致，但急诊诊疗机构患者的总停留时长更短（104 ± 88.0 分钟 vs. 179 ± 301 分钟；<i>p</i> &lt; 0.001）。两组患者的满意度均因就诊后仍存在疑虑而降低，但急诊诊疗机构患者的疑虑比例更高（32% vs. 25%；<i>p</i> = 0.003）。年龄、性别或诊断结果对患者满意度无显著影响。更多急诊诊疗机构患者表示，本次就诊的问题可由全科医师处理（57% vs. 15%；<i>p</i> &lt; 0.001），且被告知需在门诊环境下接受后续随访。在急诊诊疗机构就诊并不会导致患者整体满意度下降。急诊室与急诊诊疗机构患者的满意度均与感知到的合理等待时长呈正相关，但更多急诊诊疗机构患者认为其等待时长合理。满意度与就诊后仍存在的疑虑呈负相关；急诊诊疗机构患者的疑虑比例更高。年龄、性别或诊断结果对患者满意度无显著影响。