Objective: Evaluation of the treatment of patients with abdominal complaints at the first aid department of a city hospital, where patients were treated by emergency doctors (EMD) in combination with specialists.
Design: Retrospective, descriptive.
Setting: Onze Lieve Vrouwe Gasthuis, first aid department, Amsterdam, the Netherlands.
Patients and method: Data were collected on diagnosis, treatment and course in 3235 patients with abdominal complaints seen at the first aid department in 1997. Non-referred patients were treated by EMD who if necessary consulted a specialist. Referred patients were seen by specialists.
Results: Of the 2931 patients who visited the first aid department once, 1975 patients (67%) were seen after self-referral. Of this group, 1557 patients (79%) were treated by the EMD alone and could be sent to the general practitioner (GP) without consulting a specialist. These accounted for 53% of the 2931 patients with abdominal complaints. The EMD used fewer additional tests than the specialist. Of the patients, 91% could be treated conservatively, only 9% were operated. Fifty-three patients died. Analysis of the group of 304 patients who visited the first aid department more than once in the year of study, showed that in 28 cases the diagnosis was missed (in 17 cases by the EMD and in 11 by the specialist). Of this group 23 had to be operated upon.
Conclusion: The organisation of a first aid department like that in the OLVG, with EMDs and specialists, appeared efficient; the rates of morbidity, mortality and missed diagnoses are acceptable. With relatively few additional tests, the EMD appeared to be able to differentiate between GP care and hospital care.