Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?
Abstract Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This...
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| Format: | Article |
| Language: | English |
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BMC
2019-07-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12873-019-0257-y |
| _version_ | 1818280521622355968 |
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| author | Marjolein N. T. Kremers Prabath W. B. Nanayakkara Marcel Levi Derek Bell Harm R. Haak |
| author_facet | Marjolein N. T. Kremers Prabath W. B. Nanayakkara Marcel Levi Derek Bell Harm R. Haak |
| author_sort | Marjolein N. T. Kremers |
| collection | DOAJ |
| description | Abstract Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. Overview Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. Conclusion The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care. |
| first_indexed | 2024-12-12T23:50:33Z |
| format | Article |
| id | doaj.art-6c678f35a55f455db6c513c7c16d26fa |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-12T23:50:33Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-6c678f35a55f455db6c513c7c16d26fa2022-12-22T00:06:43ZengBMCBMC Emergency Medicine1471-227X2019-07-011911710.1186/s12873-019-0257-yStrengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?Marjolein N. T. Kremers0Prabath W. B. Nanayakkara1Marcel Levi2Derek Bell3Harm R. Haak4Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht UniversitySection Acute Medicine, Department of Internal Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmcDepartment of Medicine, University College London Hospitals NHS Foundation TrustNIHR CLAHRC Northwest London, Imperial College London, Chelsea and Westminster HospitalDepartment of Health Services Research, and CAPHRI School for Public Health and Primary Care, Aging and Long Term Care, Maastricht UniversityAbstract Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. Overview Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. Conclusion The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.http://link.springer.com/article/10.1186/s12873-019-0257-yEmergency careOrganisation of careHealth care quality |
| spellingShingle | Marjolein N. T. Kremers Prabath W. B. Nanayakkara Marcel Levi Derek Bell Harm R. Haak Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? BMC Emergency Medicine Emergency care Organisation of care Health care quality |
| title | Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? |
| title_full | Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? |
| title_fullStr | Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? |
| title_full_unstemmed | Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? |
| title_short | Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other? |
| title_sort | strengths and weaknesses of the acute care systems in the united kingdom and the netherlands what can we learn from each other |
| topic | Emergency care Organisation of care Health care quality |
| url | http://link.springer.com/article/10.1186/s12873-019-0257-y |
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