• Mirjam van Veen, Frank ten Wolde, Marten J Poley, Madelon Ruige, Alfred H J van Meurs, Cato Hablé, Ewout W Steyerberg, and Henriëtte A Moll.
• Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
• Eur J Emerg Med. 2012 Feb 1;19(1):14-9.

ObjectiveTo evaluate compliance and costs of referral of nonurgent children, who present at the emergency department, to the general practitioner cooperative (GPC).Materials And MethodsIn a prospective observational before-after study, during 6 months in 2008, the triage nurse discussed referral to the GPC with parents, when self-referred children with a nontraumatic problem, aged 3 months-16 years were triaged as nonurgent (levels 4 and 5) according to the Manchester Triage System. A telephone follow-up was performed 2-4 days after referral. Real costs were calculated for emergency department consultation (preintervention period) and GPC referral (postintervention period). Compliance of referral was studied for 4 days a week.ResultsOne hundred and forty patients were referred to the GPC, of which 101 out of 140 patients (72%) attended a follow-up. After discharge seven patients (7%) had an unscheduled revisit. No patients were subsequently hospitalized. In total 275 patients were included to study compliance, with 28 (10%) reported missing. Ninety-five out of 247 (38%) patients were referred to the general practitioner and 46 out of 247 parents (19%) refused referral. For 106 out of 247 patients (43%) referral was not initiated by the nurse mainly because of comorbidity. Mean costs per patient were €106 for the preintervention period and €101 for the postintervention period.ConclusionCompliance of referring low urgent patients is low, mainly because it was difficult for nursing staff to refer. Total overall cost benefit is minimal. Cost savings may be achieved in different settings, where general practitioner services are colocated and where large numbers can be referred.

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