Key result
Older age, more frequent prior use of the service, and presenting during periods of low call volume significantly increased the odds of requiring secondary care referral within 3 days of initial out-of-hours contact.
Observational (n=496,931)
No
Effect estimate: OR 1.010 (95% CI 1.009 to 1.011)
p-value: p=<0.001
Older patients, frequent users of out-of-hours services, and those presenting during low call volumes are at higher risk of requiring escalation to secondary care within 3 days of initial contact.
May inform risk stratification in out-of-hours services; leaves open whether targeted interventions reduce escalations.
BACKGROUND: Accurate assessment of the need for admission is challenging in out-of-hours (OOH) primary care. Understanding more about patient contacts where the decision to continue care in the community may have been incorrect could assist clinicians in assessing clinical risk. AIM: To define the population contacting OOH primary care who are at higher risk of re-presenting to this service and requiring urgent transfer to secondary care within 3 days of their initial contact. DESIGN AND SETTING: Retrospective service evaluation of 4 years of patient contacts with Oxfordshire OOH primary care. METHOD: Multivariable logistic regression was used to evaluate demographic and service delivery factors associated with increased risk of delayed escalation to secondary care. RESULTS: Almost 1% of 496 931 patients contacting OOH primary care required escalation to secondary care within 3 days. Of these, 68.5% were initially discharged with no follow-up or advice to contact their GP; 14.7% were initially referred to secondary care. The odds of requiring escalation were increased with age (odds ratio [OR] 1.010; 95% confidence interval [CI] = 1.009 to 1.011; P<0.001), more frequent prior use of the OOH service (OR 1.016; 95% CI = 1.010 to 1.021; P<0.001), and presenting during periods of low call volume (OR 0.880; 95% CI = 0.857 to 0.904; P<0.001). CONCLUSION: Older, prior users of the service, presenting at less busy times, are at greater risk of requiring secondary care referral from the OOH service within 3 days of their initial contact. These higher-risk patient groups might benefit from active follow-up by the OOH service.
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Hayward et al. (2016) conducted an observational in Out-of-hours primary care patients (n=496,931). Risk factors (age, prior use, call volume) was evaluated on Escalation to secondary care within 3 days of initial contact (OR 1.010, 95% CI 1.009 to 1.011, p=<0.001). Older age, more frequent prior use of the service, and presenting during periods of low call volume significantly increased the odds of requiring secondary care referral within 3 days of initial out-of-hours contact.
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