Assessing Urgent Referral Trends From Primary Health Care Centres to Emergency Departments in the United Arab Emirates: A Retrospective Cohort Study

BackgroundEfficient referral pathways between primary health care centres (PHCs) and emergency departments (EDs) are important for appropriate healthcare utilization and resource allocation.Limited evidence exists regarding urgent referral patterns and outcomes within the Emirates Health Services (EHS) system in the United Arab Emirates (UAE). ObjectivesThe primary objective was to characterize urgent referrals from primary health care (PHC) centres to emergency departments (EDs) within the Emirates Health Services network and evaluate diagnostic concordance, referral-to-ED arrival time, ED disposition, and 72-hour ED returns.The secondary objective was to identify factors associated with referral-to-ED arrival time, discharge against medical advice (DAMA), and 72-hour ED returns. MethodsWe conducted a retrospective cohort study of adult urgent PHC-to-ED referral encounters across 63 EHS primary health care centres from January 1, 2024, to December 8, 2025.Data was extracted from the Wareed electronic medical record system and analyzed using descriptive and multivariable statistical methods. ResultsA total of 475 urgent referral encounters were analyzed.Patients aged ≥51 years constituted the largest age group (n=235, 49.5%), 255 (53.7%) were male, and 384 (80.8%) belonged to the Middle Eastern nationality group.Cardiovascular conditions accounted for the largest proportion of provisional PHC diagnoses (n=120, 25.3%), followed by respiratory (n=70, 14.7%) and neurological disorders (n=58, 12.2%).Diagnostic agreement between PHC provisional and ED final diagnoses was moderate (κ=0.453,95% CI: 0.400-0.506;p<0.001), with an overall concordance of 258 (54.4%).Most referral encounters resulted in discharge from the ED with medical approval (n=380, 80.0%), and 31 (6.5%) returned to the ED within 72 hours.The median referral-to-ED arrival time was 82.5 minutes (IQR: 55.8-119.1).Male sex was associated with higher odds of 72-hour ED return than female sex (aOR=2.79;95% CI: 1.20-6.46;p=0.017), and discharge against medical advice (DAMA) was also associated with higher odds of return (aOR=2.30;95% CI: 1.00-5.27;p=0.049). ConclusionsModerate diagnostic concordance between PHC provisional and ED final diagnoses suggests potential opportunities for quality-improvement initiatives focusing on diagnostic assessment, referral documentation, and care coordination.Further prospective research is needed to determine whether targeted interventions improve referral processes, resource utilization, and patient outcomes.