Abstract

Policymakers and healthcare planners have long been concerned with reducing the number of unnecessary referrals to emergency departments (EDs). This systematic review aimed to determine if referrals to hospital EDs by primary care physicians and family physicians were appropriate. The review was conducted following PRISMA guidelines. Search terms were developed through a limited search of the databases Medline, CINAHL, Web of Science, and Embase. Items published in English between 2009 and 2024 were considered. Both qualitative and quantitative research conducted in English, examining whether family doctors and primary healthcare (PHC) providers should refer patients to hospital emergency rooms, were included. Our study included six publications, covering a total of 8,081 patients. Medical complaints were the least common condition referred to emergency care, while musculoskeletal injuries were the most common. Other medical issues documented included skin and wound abscesses, and edema. Inadequate clinical documentation was the primary reason most referrals were deemed inappropriate, according to one study. Another study found a diagnostic correlation of more than 70% between PHC referrals to the emergency room and appropriate recommendations, with a referral rate exceeding 80%. The primary cause of inappropriate referrals was inadequate clinical documentation. Primary healthcare physicians referrals may result from difficult decisions regarding the necessity of admission and often require the use of ED services.

Key words: Emergency department; primary healthcare; family physicians; referral