Describing the patient trajectory for unplanned care in a region of Flanders, Belgium: A prospective observational study

Demand for unplanned care in Belgium is high, placing pressure on both out-of-hours primary care facilities (OOHPCF) and emergency departments (ED). Understanding patient trajectories may help optimise care pathways and resource planning for planned and unplanned care. To describe patient presentations and trajectories at OOHPCF and EDs in a region of Flanders, Belgium. Data were collected in six EDs and three OOHPCF in the greater {redacted} region. All consultations were recorded during three randomly selected days in EDs and one full week in OOHPCF in 2024. A total of 1,469 ED and 857 OOHPCF consultations were analysed. In EDs, trauma was the most common presentation (32%), followed by ear, nose and throat (ENT) and dermatology conditions (22%). In OOHPCF, trauma and orthopaedic problems accounted for 20% of consultations, followed by ENT (17%) and dermatology (14%). Most ED patients (71%) were discharged home. Self-referral accounted for 65% of ED visits; these patients were generally younger and presented with lower-acuity conditions. One in five patients had consulted another healthcare provider within the previous week. Pain and worry were the main drivers for attendance. Attending clinicians in both settings considered up to one-third of consultations manageable in planned care. Rather than restricting access or apportioning blame to patients, our findings indicate the need to reassess measures throughout planned and unplanned care pathways for timely access to the most appropriate care setting while maintaining patient safety and equitable access to services. One third of unplanned care consultations were perceived as manageable in planned care.Key drivers for unplanned care were pain and patient worry about their symptoms.Our findings signal the need to re-evaluate strategies for timely access to appropriate care while maintaining patient safety and equitable access to services. One third of unplanned care consultations were perceived as manageable in planned care. Key drivers for unplanned care were pain and patient worry about their symptoms. Our findings signal the need to re-evaluate strategies for timely access to appropriate care while maintaining patient safety and equitable access to services.