Quick diagnosis units: avoiding referrals from primary care to the ED and hospitalizations

• Published in: The American journal of emergency medicine Vol. 31; no. 1; pp. 114 - 123
• Main Authors: Bosch, Xavier, MD, PhD, Jordán, Anna, NP, López-Soto, Alfonso, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013; Elsevier Limited
• Subjects: Cancer; Chi-Square Distribution; Cost control; Diarrhea; Emergency; Emergency medical care; Emergency Service, Hospital - economics; Emergency Service, Hospital - utilization; Female; Hospital Costs; Hospital Units - economics; Hospital Units - organization & administration; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Humans; Internal medicine; Irritable bowel syndrome; Longitudinal Studies; Male; Middle Aged; Patient admissions; Patient satisfaction; Primary Health Care; Prospective Studies; Referral and Consultation - economics; Referral and Consultation - statistics & numerical data; Retrospective Studies; Statistics, Nonparametric; Surveys and Questionnaires; Spain
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2012.06.013

Abstract Purpose The aim of the present study was to determine whether quick diagnosis units (QDUs) can safely and efficiently avoid emergency department (ED) visits and hospitalizations. Patients and Methods We included a prospective cohort of 4170 consecutive patients and a retrospective cohort of 3030 hospitalized patients. Medical records of hospitalized patients were reviewed to determine whether patients were stable enough for outpatient diagnostic workup. We studied primary care (PC) and ED referral patterns in two 25-month periods. Hospital and QDU costs were analyzed by microcosting techniques, and a survey was evaluated using care preferences. Results From December 2007 to December 2009, 66% QDU patients were referred from PC to ED and 25% from PC to QDU. From January 2010 to January 2012, 35% QDU patients were referred from PC to ED and 53% from PC to QDU (P < .0001). During the first period, 36% ED patients were referred to QDU and 65% (retrospective cohort) were hospitalized, compared with 64% and 35%, respectively, during the second period (P < .0001). Between 84% and 91% of hospitalized patients were stable for QDU workup, and their hospitalization might have been avoided. Cost per process was €3241.11 in hospitalized patients and €726.47 in QDU patients. Most patients preferred the QDU model and were reluctant to first being transferred to ED. Conclusions An increasing number of PC and ED patients were referred to the QDU. Hospitalizations might have been avoided in at least 84% of patients. Although QDU and hospitalization are similarly effective in reaching a diagnosis, the QDU model incurs fewer costs.