• Borge Lillebo, Bodil Dyrstad, and Anders Grimsmo.
• Out-of-Hours Primary Care Centre, Varnesregionen, Stjørdal, Norway. borge.lillebo@varnesregionen.no
• Emerg Med J. 2013 Sep 1;30(9):707-11.

BackgroundUse of specialist healthcare services is increasing.AimTo evaluate whether alternative healthcare services could reduce the need for admissions to specialist care hospitals.DesignProspective observational study of emergency referrals for admission to specialist care.SettingA single out-of-hours primary care centre (OPCC) in Norway.MethodOut-of-hours physicians registered their referrals for hospital admission and stated whether the admission could have been avoided given the availability of six other healthcare services.ResultsOf 1083 registered encounters at the OPCC, 152 (14%) were referred for specialist care hospital admission. According to the referring physician, 32 (21%) of these referrals could have been avoided. The most eligible alternatives to such referrals were next-day appointments at a specialist outpatient clinic (11 of 32 referrals), or admission to a community hospital (21 of 32 referrals), or a nursing home (nine of 32 referrals). Respiratory (eight of 32 referrals) and gastrointestinal problems (12 of 32 referrals) were the most common among avoidable admissions.ConclusionsThe use of specialist care hospital admission can be reduced if appropriate alternatives are available.

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