Impact of ongoing centralization of acute stroke care from "drip and ship" into "direct-to-mothership" model in a Dutch urban area.

When acute stroke care is organised using a "drip-and-ship" model, patients receive immediate treatment at the nearest primary stroke centre followed by transfer to a comprehensive stroke centre (CSC). When stroke care is further centralised into the "direct-to-mothership" model, patients with stroke symptoms are immediately brought to a CSC to further reduce treatment times and enhance stroke outcomes. We investigated the effects of the ongoing centralization in a Dutch urban setting on treatment times of patients with confirmed ischemic stroke in a 4-year period.

Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral.

Background: Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility.

Walkouts from the emergency department: characteristics, reasons and medical care needs.

Objectives: The aim of this study was to assess the walkout rate and to identify influencing patient and visit characteristics on walkout. Furthermore, we assessed the reasons for leaving and medical care needs after leaving.

Methods: In a 4-month population-based cohort study, the characteristics and influencing factors of walkout from two emergency departments in the Netherlands were studied.