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Registrars’ high ED referral rates reflect ‘best practice’ training


Matt Woodley


5/02/2019 4:06:18 PM

General practice registrars refer patients to emergency departments at nearly twice the rate of their established colleagues, a study has revealed.

Data from the study was drawn from five of Australia’s 17 general practice regional training providers across five states, encompassing urban, rural, remote and very remote practices.
Data from the study was drawn from five of Australia’s 17 general practice regional training providers across five states, encompassing urban, rural, remote and very remote practices.

The report, led by Mr Nigel Catzikiris and Ms Amanda Tapley from GP Synergy and the University of Newcastle, analysed contributed data from 1161 general practice registrars that encompassed 166,966 consultations and 258,381 individual problems.
 
However, while registrar emergency department (ED) referral rates were much higher than their more experienced colleagues, the study authors state this is partly due to the acute nature of the presentations traditionally faced by trainee GPs, which present unique learning opportunities.
 
‘The significant association of ED referrals with the seeking of in-consultation information or assistance reflects the seriousness of these presentations and that the patient would still likely have been referred to the ED if seen by a senior GP rather than by the registrar,’ the authors noted.
 
The study authors state that the higher likelihood of acute presentations and their associated requests for in-consultation assistance demonstrate the importance of general practice supervisors in facilitating ED referral appropriateness, as well as the development of registrars’ safe clinical practice.
 
‘There is strong opinion that improved understanding of the epidemiology of ED referral patterns of Australian GPs can inform GP-relevant strategies to address ED demand: for example, training, feedback and peer support of appropriate GP ED referral decision making have been advocated,’ the report states.
 
‘The finding that registrars were more likely to generate learning goals from ED-referred problems indicates these were true learning experiences for the registrars, reflecting vocational training best-practice and self-directed learning rather than simple delegations of responsibility to ED colleagues.’
 
Data from the study was drawn from five of Australia’s 17 general practice regional training providers (RTPs) across five states, encompassing urban, rural, remote and very remote practices. It was recorded between 2010 and 2015 as part of the Registrar Clinical Encounters in Training (ReCEnT) study.
 
Around two thirds of the registrars were female, while 80% were qualified as a doctor in Australia. Nearly 72% had not worked at the practice previously, and 82% of the practices did not routinely bulk bill.
 
Patients aged 0–14 years of age accounted for 13.68% of presentations but 24% of ED referrals, while patients new to the registrar were also overrepresented in terms of ED referrals. 
 
Future research is expected to focus on inter-RTP variances in referral patterns.



emergency department general practice registrars referral


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