RT Journal Article SR Electronic T1 Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation JF British Journal of General Practice JO Br J Gen Pract FD British Journal of General Practice SP BJGP.2021.0090 DO 10.3399/BJGP.2021.0090 A1 Alison Cooper A1 Andrew Carson-Stevens A1 Michelle Edwards A1 Freya Davies A1 Liam J Donaldson A1 Pippa Anderson A1 Matthew Cooke A1 Jeremy Dale A1 Bridie Angela Evans A1 Barbara Harrington A1 Julie Hepburn A1 Peter Hibbert A1 Thomas Hughes A1 Alison Porter A1 Aloysius Niroshan Siriwardena A1 Helen Snooks A1 Adrian Edwards YR 2021 UL http://bjgp.org/content/early/2021/10/18/BJGP.2021.0090.abstract 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 This study 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 Realist methodology with a purposive sample of 13 EDs in England and Wales with different GP service models. The study 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 Qualitative data were collected (observations, semi-structured audio-recorded staff interviews, and local patient safety incident reports). Data were coded 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 The authors 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 The findings of this study can be used as a focus for more in-depth human factors investigations to optimise work conditions in this complex care delivery setting.