| Project Objectives / Summary:
This project was undertaken by the Division to reintegrate GPs back into rural Emergency Departments. The program model combined the delivery of high quality education with procedural training in emergency medicine to GPs. It arose from a 1999 survey that revealed many GPs were keen to work in Emergency Departments but had lost confidence in their skills and in use of new technology.
The project was undertaken for the purpose of:
- Meeting the gaps in the hospital medical workforce in rural areas;
- Providing a different component of care to that provided by hospital medical staff;
- Provide better utilisation of the GP workforce; and
- Better coordination of patient care both within the hospital and in the community
The project aimed to provide GPs de-skilled in emergency medicine with appropriate training and support to re-enter the hospital setting by:
- Reintegrating GPs into the acute care setting;
- Providing Emergency Departments with experienced GPs to reduce admissions to hospital and unnecessary investigations;
- Providing GPs de-skilled in emergency medicine with appropriate training and support to increase their confidence in working in the Emergency Department;
- Reducing the backlog of primary care patients in hospital Emergency Departments; and
- Strengthening links between GPs, hospitals and specialists in the acute care setting.
Project Collaboration:
- Mid North Coast Area Health Service
- Emergency Department of Coffs Harbour Base Hospital
Project Outcomes:
Results of the survey showed the program had contributed to a significant increase in the confidence/skill levels of GPs to work in the Emergency Department. A reduction from 23 to six specific emergencies and procedures GPs were not confident in dealing with was reported since the commencement of the program. As a result of the program, GPs reported they were confident in their clinical skills to deal with emergencies and procedures across 12 major domains of Emergency Medicine.
The survey also identified specific GP education and training needs that were addressed by providing:
- 18 GPs with access to the Emergency Life Support Course
- 7 GPs with access to Radiology in Accident and Emergency training
- 2 GPs with access to regular ED fracture clinics
- 14 GPs with access to Cardiopulomonary resuscitation CME training
- 22 GPs with access to high quality CME delivered by a ED staff specialist
- Participating GPs with Emergency Medicine education books
The development of GP confidence and skills to deal with emergencies and procedures was validated by the qualitative survey findings. GPs reported overwhelming satisfaction with the success of the program in providing appropriate training and support to increase their confidence in working in the Emergency Department.
Increased interaction between GPs and ED staff was reported as a result of the reintegration program. Strengthened links between GPs, hospitals and specialist in the acute care setting was represented by emergent themes of improved communication, understanding and awareness between GPs and ED staff.
Each respondent reported a perception that their involvement in the upskilling program and particularly, their work in the Emergency Department had alleviated the medical practitioner workload in the ED setting.
Each GP also reported a renewed interest and confidence to continue working and training in the ED setting as a result of their program experience.
Evaluation of the baseline and follow up Hospital Performance Target records failed to provide any evidence that the program to reintegrate GPs into the ED setting alleviated the ED workload through reduced admissions, unnecessary investigations or throughput of primary care patients. However, findings from the qualitative surveys reveal a general perception that they did reduce the primary care component of the ED workload.
Recommendations:
That other Divisions and Area Health Services refer to the project model to 'Reintegrate GPs into Rural Emergency Departments' as a guide to better utilise the rural GP workforce in support of Emergency care across the rural health setting.
That Commonwealth and State Departments of Health provide collaborative support for the establishment of schemes to ensure GPs, particularly those working in EDs of small rural hospitals, have access to Advanced Emergency Medicine upskilling programs.
That GPs are provided with greater access to advanced short term emergency medicine courses, including the ELS, ELMST and Advanced Paediatric Life Support Course (APLS) courses.
The Commonwealth and State Health Departments consider the ongoing funding of programs to reintegrate GPs back into Rural Emergency Departments as a cost effective method of meeting gaps in the rural ED workforce. This recommendation is supported by program incentives to recruit GPs into rural areas in the form of professional development and supporting opportunities.
Disseminating Project Information:
Publications:
Copies of the final report were forwarded to:
- Mid North Coast Division GPs
- All Divisions of General Practice
- State Based Organisations
- University Departments of General Practice
- A poster was prepared for display at various functions and conferences
Lessons / Assessment:
There was some disruption to the project because of a change in Project Officer, particularly relating to arranging access to specialised training courses, monitoring / modification of training and education, and the completion of project evaluation prior to the nominated project completion date. For this reason, an extension of the project was granted to allow appropriate evaluation and dissemination of the project findings.
The program results highlight the importance of ensuring GPs and CMOs working in EDs are provided with access to relevant Advanced Emergency education courses to complement procedural training. The most significant shortcoming of the program was found to be the inability to provide GPs with access to the Advanced Paediatric Life Support course which is reflected by the lack of development in confidence and skills recorded in this area.
This was a practical project that met its aims. The Division has also been active in disseminating its experience. |
