Streaming patients from emergency to primary care: to what degree do patients self-triage?

Cooper and colleagues discuss the underappreciated and key topic of streaming patients in emergency departments to primary care services.1 With stresses on emergency departments increasing, there is an obvious draw to use out-of-hours general practitioner services to meet the demands of the non-urgent, avoidable attendances shown to average roughly 19% of presentations to UK emergency departments.2

A current model allows for patients to be streamed from emergency departments to integrated or onsite GP services or for patients to attend the GP services directly. We don’t currently know whether patients who choose to attend emergency departments and are subsequently streamed to the GP services are a different patient group with different presentations and outcomes compared with those who decide to attend the GP services directly. Effectively, to what degree do patients self-triage? I think this is a key patient safety question that would require further investigation before advocating the use of direct streaming of such patients away from the emergency department.