#GPFUQ
193 What’s
the weakest link in the chain of care? Attempts to reduce emergency hospital admissions
should focus on all the people (patients, their carers and clinicians) at high
risk.
If better care is available outside of hospitals the rising demand for the care of
patients with chronic conditions is hard to understand. It’s the weakest link
in a chain of people at risk that’s important. The links are weak and the risk
of emergency admission high when patients, their carers and clinicians each has
to struggle to cope with a mix of complex medical and social conditions, the
plethora of services available, perverse guidelines and incentives that confuse
best practice, and the lack of effective feedback loops to inform their choices
about care. The weakest link can be anywhere in the chain of people and
services.
For example one of the many factors in the mix is the GP. A series of
studies of GP Out of hours services in Bristol (Reference 1) showed a marked (a
four fold) variation in emergency referrals between the top and bottom
quartiles of referrers and a ten fold difference between the top ten and the
bottom ten referrers. A low `tolerance of risk' by the GP seemed to be
the weak link that predicts emergency referrals. Strengthening this weak
link and each weak link in the chain by making the differences in behaviour
visible by better feedback to the patients, carers and clinicians might reduce
variation in performance and improve quality. Better knowledge and
understanding of risk needs to be shared with out patients when making
decisions about their care.
Reference
Risk taking in general
practice: GP out-of-hours referrals to hospital
Authors: Ingram,
Jenny; Calnan, Michael; Greenwood, Rosemary J; Kemple,
Terry; Payne, Sarah; Rossdale, Michael
