PT  - JOURNAL ARTICLE
AU  - Alison Cooper
AU  - Andrew Carson-Stevens
AU  - Michelle Edwards
AU  - Freya Davies
AU  - Liam Donaldson
AU  - Pippa Anderson
AU  - Matthew Cooke
AU  - Jeremy Dale
AU  - Bridie Angela Evans
AU  - Barbara Harrington
AU  - Julie Hepburn
AU  - Peter Hibbert
AU  - Thomas Hughes
AU  - Alison Porter
AU  - Aloysius Niroshan Siriwardena
AU  - Helen Snooks
AU  - Adrian Edwards
TI  - Identifying safe care processes when GPs work in or alongside emergency departments: realist evaluation
AID  - 10.3399/BJGP.2021.0090
DP  - 2021 May 21
TA  - British Journal of General Practice
PG  - BJGP.2021.0090
4099  - http://bjgp.org/content/early/2021/05/21/BJGP.2021.0090.short
4100  - http://bjgp.org/content/early/2021/05/21/BJGP.2021.0090.full
AB  - Background: Increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments (EDs), but with a lack of evidence for patient safety outcomes. Aim: We aimed to explore how care processes work and how patient safety incidents associated with GPs working in ED settings may be mitigated. Design and Setting: We used realist methodology with a purposive sample of 13 EDs with different GP service models. We sought to understand the relationship between contexts, mechanisms and outcomes to develop theories about how and why patient safety incidents may occur, and how safe care was perceived to be delivered. Method: We collected qualitative data (observations, semi-structured audio-recorded staff interviews and local patient safety incident reports). We coded data using ‘if, then, because’ statements to refine initial theories developed from an earlier rapid realist literature review and analysis of a sample of national patient safety incident reports. Results: We developed a programme theory to describe how safe patient care was perceived to be delivered in these service models including: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision-making with clear governance processes relevant to the intended role (traditional GP approach or emergency medicine approach); and strong clinical leadership to promote teamwork and improve communication between services. Conclusion: Our findings can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting.