Understanding the consequences of GP referral thresholds: taking the instrumental approach

Trade-offs between patient safety and efficient use of healthcare services occur in clinical decisions across all forms of healthcare. In the case of acutely unwell older patients, decisions about referral to hospital involve trade-offs between the safety associated with inpatient hospital treatment and the burden on both the patient and health system associated with hospital admission. In many healthcare systems, these decisions are largely made by general practitioners (GPs), often without first-hand knowledge of the patient, especially when presentation is in an out-of-hours setting. This raises three questions: how much do practitioners vary in their decisions? is this variation systematic (ie, after adjusting for patient and context, do some practitioners have a greater or lesser tendency to refer than others?)? and are those who make fewer referrals making better decisions (ie, admitting those who will benefit, keeping at home those who will not)? In this issue of BMJ Quality...
Source: BMJ Quality and Safety - Category: General Medicine Authors: Tags: Editorials Source Type: research