Mandatory referral for unplanned hospital admissions led to a 9.4% reduction in attendances

Emergency departments around the world are reporting increased activity and thus increased risk of crowding [1]. As crowding is a high-risk situation for patients and staff with potentially detrimental outcomes [2], hospital owners and governmental bodies are trying to control patient influx [1, 3]. One way to limit emergency department access is to require prior mandatory referral from a primary healthcare provider. From 2011 to 2014, Denmark implemented nationwide mandatory referral for access to an emergency department, and a similar scheme was recently introduced in the UK [4]. Danish citizens are now required to either contact a general practitioner, request emergency medical services, or call a hotline staffed by experienced emergency nurses. This letter describes the effect of such mandatory referral on the number of hospital attendances.