Emergency care access to primary care records: an observational study

Objective: To measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access. Measures: Rates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission. Design: A retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients' primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories. Results: 6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=-9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=-36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081). Discussion: Emergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories. Conclusion: Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.