Journal of General Practice

Objective Clinicians, policymakers, and patients are all concerned about the substantial increase in emergency hospital admissions that has occurred in England and Wales in recent years. However, nothing is known about the elements that affected this choice. We sought to determine the potential impact of non-clinical variables on hospital admission rates. Method 21 participants from three acute hospital trusts participated in semi structured interviews with us. 11 emergency department (ED) doctors, 3 ED nurses, 3 supervisors, and 4 inpatient doctors were among the participants. These roles covered a wide range of seniority. The authors established a theoretical framework to explain admission decision-making, and important aspects from that framework served as the basis for interview questions. Two separate researchers used framework analysis to record, transcribe, and analyse the interviews. Findings Non-clinical influences on the choice to admit as opposed to discharge patients were identified as departmental elements like workload, time of day, and levels of senior assistance. Although generally viewed as favourable, the 4-hour waiting time target was criticised for influencing patient admission decisions regardless of clinical need. External factors including a patient's social support network and community follow-up were widely acknowledged as having a significant impact on admission. Finally, it was stated that the ED culture had a significant influence (either positively or adversely) on the choice to admit patients.

These events frequently have an impact on the health system's capacity to effectively manage emergency risk and offer access to high-quality care because they interfere with a number of crucial aspects of the delivery of healthcare. This covers geographic facility accessibility, the availability of a skilled medical workforce, and the accessibility of money. It also covers problems with supply-chain management, such as insufficient resources, the infrastructure of medical facilities, and the availability of electricity and water. Government control, the existence of good leadership and organisational management are important as well but may be lacking in an emergency. In emergency situations, health staff may be particularly exposed. This may be due to a number of factors, such as the increased workload and psychological stress they experience.

The intricate relationships in the delivery of healthcare are addressed by health systems science. Health systems science, which helps patients navigate the complex and frequently confusing US healthcare delivery system, focuses on the minute elements needed to give high-quality care to specific patients. In order to give patients with efficient, affordable, and high-quality care, modern doctors must have a solid working knowledge of health systems science. This is due to advancements in technology, informatics, and communication.

Objective: General Practitioners (GPs) have an important role in the Dutch system of external post-mortem examination (E-PM). They perform at least 50% of the E-PMs. This research aims to study the competence of the GPs in the Netherlands in performing E-PMs. To achieve this, a survey was performed amongst GPs. The study analysed if GPs felt competent to perform E-PMs, if they had knowledge of and acted according to the Dutch Burial Act and if they were consistent in their acts and thoughts.

Methods: An online survey conducted amongst GPs resulted in 225 datasets, after excluding 36 surveys for various reasons.

Results: There was no significant difference in the feeling of competence between GPs (79.47%) and GP registrars (86.49%). Of all the respondents 40.89% were consistent in their acts and thoughts on the matter of E-PMs and 33.78% of respondents scored a 100% on legal knowledge? Of all the respondents that felt competent 47.28% showed inconsistency in acts and thoughts as well as lack of legal knowledge.

Conclusion: Although every physician in the Netherlands is qualified to perform E-PMs, this research shows this does not automatically imply they are competent to do so. The inconsistency in acts and thoughts and/or the lack of legal knowledge in the matter of E-PMs undermines the current Dutch system of death investigations.