Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 140 No. 4344 (2010)

Primary care emergency services utilisation in German speaking Switzerland

  • U Güntensperger
  • R Pinzello-Hürlimann
  • A Ciurea
  • B Muff
  • JP Gutzwiller
Cite this as:
Swiss Med Wkly. 2010;140:w13111


BACKGROUND: Traditionally, emergency consultations have been done by a general practitioner (GP) in Switzerland. Over the last years, there seems to have been a shift between general practice to hospital emergency ward utilisation. There are several local initiatives of general practitioners and hospitals to change the organisation of emergency care. To plan a new organisation form of emergency care, delivery should be based on population based data.

OBJECTIVE: The aim of the study was to investigate the epidemiology and distribution of emergency consultations of primary care in a hospital and in a practice of general practitioners. In addition, factors of clinical performance in emergency consultations are of great public health interest.

METHODS: For this survey, all emergency patient contacts of general practitioners from the catchment area of Bülach, serving 27 088 inhabitants, were assessed by a questionnaire during the fourth quarter of 2006. Sex, age, time, duration of the contact and triage diagnosis were assessed. In addition, all patients seen by the emergency ward at the local hospital were assessed. Contact rates and hospitalisation rates per 100 000 inhabitants were determined. In addition, a multiple linear regression model was performed to determine factors associated with consultation time as a marker for clinical performance.

RESULTS: Between October 1th and December 31th 2006, 1001 patient contacts were registered at the same time period in the hospital and general practice. The patient contact rate was 94.8 contacts per 100 000 inhabitants per day, and the hospitalisation rate was 9.1 patient per 100 000 inhabitants. Patients seen at the hospital were older than in general practice (41.2 ± 22.8 vs. 32.6 ± 26.3 years) and consultation and waiting time was longer in the hospital than consultation time with the GP (144.8 ± 106.5 vs. 19.6 ± 17.6 minutes).

CONCLUSION: Nearly 1 out of 1000 inhabitants were looking for emergency primary care help, and 10% of the patients were seen urgently by general practitioners and hospital staff and were hospitalised. These numbers are important information for planning emergency primary care facilities. The most prevalent triage diagnoses in practice are infections, traumatological reasons and ENT-problems, whereas in hospital the most frequent triage diagnosis is a traumatological disorder, followed by thoracic pain and infections. In addition, GP’s treat patients more rapidly than a hospital does and treat patients in shorter time intervals.


  1. Bernstein AB, Hing E, Moss AJ, Allen KF, Siller AB, Tiggle RB. Health care in America: trends in utilization [DHHS Publication No. 2004-1031]. Hyattsville, MD: National Center of Health Statistics; 2003.
  2. Derlet R, Richard J, Kravitz R. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med. 2001;8:151–5.
  3. Santos-Eggimann B. Increasing use of the emergency department in a Swiss hospital: observational study based on measures of the severity of cases. BMJ. 2002;324:1186–7.
  4. Flaig C, Zehnder K, Zürcher H, Eichenberger P, Frei C, Gegeckas A, et al. Selbsteinweisungen ins Spital. PrimaryCare. 2002;2:280–3.
  5. Schwappach DLB, Blaudszun A, Conen D, Ebner H, Eichler K, Hochreutener MA. “Emerge”: benchmarking of clinical performance and patients’ experiences with emergency care in Switzerland. International Journal for Quality in Health Care 2003;15(6): pp. 473–85.
  6. Arnet B, von Below G. Organisation des ambulanten ärztlichen Notfalldienstes in der Schweiz. 2002
  7. Hugentobler W. Kostenvergleich der ambulanten Notfallversorgung in der hausärztlichen Praxis mit den Notfallstationen der Spitäler. PrimaryCare. 2006;6:586–9.
  8. Marty F, Meyer R, Lüscher S, Gnädinger M, Kissling B. Dringliche Konsultationen/Notfälle beim Hausarzt – eine Pilotstudie. PrimaryCare. 2006;6:345–7.
  9. Statistisches Amt des Kantons Zürich, Blicherweg 5, 8090 Zürich.
  10. Hannaford PC, Simpson JA, Bisset AF, Davis A, McKerrow W, Mills R. The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract. 2005;22:227–33.
  11. Zakariassen E, Burman RA, Hunskaar S. The epidemiology of medical emergency contacts outside hospitals in Norway – a prospective population based study. Scand J Trauma Resusc Emerg Med. 2010;18:9.
  12. Christen ST. Cerumen obturans – 500 Franken. Schweiz. Ärztezeitung. 2006;87(8):301.
  13. Travers JP, Lee FCY. Avoiding prolonged waiting time during busy periods in the emergency department: is there a role for the senior emergency physician in triage? Eur J Emerg Med. 2006;13:342–8.
  14. Sicras-Mainar A, Pané-Mena O, Martínez-Ruíz T, Fernández-Roure JL, Prats-Sánchez J, Santafé L, et al. Utilización de los grupos clínicos ajustados en un centro de atención primaria español: estudio retrospectivo de base poblacional. Rev Panam Salud Publica. 2010;27:49–55.
  15. Hannaford PC, Smith BH, Elliott AM. Primary care epidemiology: its scope and purpose. Fam Pract. 2006;23:1–7.
  16. McCusker J, Karp I, Cardin S, Durand P, Morin J. Determinants of emergency department visits by older adults: a systematic review. Acad Emerg Med. 2003;10:1362–70.
  17. Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur AM, Roberge D, Larouche D, et al. Continuity of primary care and emergency department utilization among elderly people. CMAJ. 2007;177:1362–8.
  18. Tschudi P. Der Hausarzt – Spielball der Patienten und der Gesundheitspolitik? PrimaryCare. 2009;9:158–62.