Predicting clinical deterioration after initial assessment in out-of-hours primary care: a retrospective service evaluation

Gail N Hayward, Charles Vincent, Daniel S Lasserson

Accurate assessment of the need for admission is challenging in out-of-hours (OOH) primary care. Understanding more about patient contacts where the decision to continue care in the community may have been incorrect could assist clinicians in assessing clinical risk. To define the population contacting OOH primary care who are at higher risk of re-presenting to this service and requiring urgent transfer to secondary care within 3 days of their initial contact. Retrospective service evaluation of 4 years of patient contacts with Oxfordshire OOH primary care. Multivariable logistic regression was used to evaluate demographic and service delivery factors associated with increased risk of delayed escalation to secondary care. Almost 1% of 496 931 patients contacting OOH primary care required escalation to secondary care within 3 days. Of these, 68.5% were initially discharged with no follow-up or advice to contact their GP; 14.7% were initially referred to secondary care. The odds of requiring escalation were increased with age (odds ratio [OR] 1.010; 95% confidence interval [CI] = 1.009 to 1.011; P<0.001), more frequent prior use of the OOH service (OR 1.016; 95% CI = 1.010 to 1.021; P<0.001), and presenting during periods of low call volume (OR 0.880; 95% CI = 0.857 to 0.904; P<0.001). Older, prior users of the service, presenting at less busy times, are at greater risk of requiring secondary care referral from the OOH service within 3 days of their initial contact. These higher-risk patient groups might benefit from active follow-up by the OOH service.