Is the general practitioner hospital a potential 'patient trap'? A panel study of emergency cases transferred to higher level hospitals

Abstract

Objectives - 1. To find out whether a stay in local general practitioner hospitals (GP hospitals) prior to an emergency admission to higher level hospitals aggravated or prolonged the course of the disease, or contributed to permanent health loss for some patients. 2. To detect cases where a transitory stay in a GP hospital might have been favourable. Design - A retrospective expert panel study based on records from GP hospitals and general hospitals. The included patients had participated in a previous prospective study of consecutive admissions to GP hospitals during 8 weeks. Setting - Fifteen out of 16 GP hospitals in Finnmark county, Norway. Subjects - Seventy-three patients transferred to higher level hospitals from a total of 395 admitted to GP hospitals. Main outcome measures - Three outcome categories were considered for each patient: 'possible permanent health loss', 'possible significantly prolonged or aggravated disease course', and 'possible favourable effect on the disease course'. Results - There was agreement about the possibility of negative effects in two patients (2.7%), while a possible favourable influence was ascribed to six cases (8.2%). Conclusion - Negative health effects due to transitory stays in GP hospitals are uncommon and moderate, and balanced by benefits, particularly with regard to early access to life saving treatment for critically ill patients.