Triage
Conditions
Keywords
Triage, Primary Health Care, Emergency Service, Hospital
Brief summary
Introduction: Patients who might also go to the general practitioner (GP) frequently consult emergency departments (ED). This leads to additional costs for both government and patient and a high workload for emergency physicians in Flanders. The Belgian government wants to address this problem by improved collaboration between EDs and general practice cooperatives (GPCs). Intervention: Patients presenting at the ED during out-of-hours (OOH) will be triaged and allocated to the most appropriate service. For this purpose the Manchester Triage System (MTS) which is commonly used in Flemish hospitals, will be extended (eMTS). By doing so a trained nurse will be able to diverge suitable patients towards the GPC. Methodology: The investigators will conduct a cluster randomised controlled trial in which eligible ED patients will be diverged to the GPC using the eMTS. The investigators will collect data using the iCAREdata database. The investigators will study the use of the eMTS, the effectiveness and effects of triage, work load changes, epidemiology at both departments, patient safety, health insurance (HIS) and patient expenditures. Furthermore, facilitators and barriers will be studied and an incident analysis of problem cases will be performed. Outcome: The primary outcome is the proportion of patients who enter the ED and are handled by the GP after triage. Secondary outcome measurements are related to safety: referral rate to the ED by the GP, proportion of patients not following the triage advice and file review for selected patients.
Interventions
OTHERTriage with referral to primary care
During intervention weekends(and holidays) a nurse will triage patients using a newly developped extended Manchester Triage System (eMTS). Patients appropriate for primary care will be referred to the general practitioner on call.We will inform patients about the nature of the intervention using leaflets and broadcasting in the waiting room of the Emergency Department.
OTHERUsual care
During a control weekend (and holidays), all data registration and collection will be the same as during intervention weekends but patents will not be informed about their allocation advice. The emergency physician will see all patients deciding to stay at the ED, without influence of the triage advice. As in standard clinical care, patients will have the right to change their mind and go spontaneously to the general practitioner. . During control weekends, we will only inform about triage in general but no about the general practioner or the intervention.
Sponsors
University Hospital, Antwerp
Research Foundation Flanders
Universiteit Antwerpen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Cluster randomised with weekends servings as clusters.
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* availability of a Belgian citizen national insurance number
Exclusion criteria
* Patients arriving at the ED by an ambulance with a doctor or nurse * Patients all ready admitted to an other hospital department
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral | Patient flow will be followed for 24 hours after presentation at the ED | The difference between intervention and control period will be calculated. Treatment at the GPC means having a record at the GPC. |
Countries
Belgium
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Triage With Referral to Primary Care Triage and referral according to eMTS.
Triage with referral to primary care: During intervention weekends(and holidays) a nurse will triage patients using a newly developped extended Manchester Triage System (eMTS). Patients appropriate for primary care will be referred to the general practitioner on call.We will inform patients about the nature of the intervention using leaflets and broadcasting in the waiting room of the Emergency Department. | 6,374 |
| Triage Without Referral to Primary Care Weekends with usual care
Usual care: During a control weekend (and holidays), all data registration and collection will be the same as during intervention weekends but patents will not be informed about their allocation advice. The emergency physician will see all patients deciding to stay at the ED, without influence of the triage advice. As in standard clinical care, patients will have the right to change their mind and go spontaneously to the general practitioner. . During control weekends, we will only inform about triage in general but no about the general practioner or the intervention. | 1,784 |
| Total | 8,158 |
Baseline characteristics
| Characteristic | Triage With Referral to Primary Care | Triage Without Referral to Primary Care | Total |
|---|---|---|---|
| Age, Continuous | 38 years STANDARD_DEVIATION 25 | 39 years STANDARD_DEVIATION 24 | 38 years STANDARD_DEVIATION 25 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 6374 Participants | 1784 Participants | 8158 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Female | 3149 Participants | 880 Participants | 4029 Participants |
| Sex: Female, Male Male | 3225 Participants | 904 Participants | 4129 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 6,294 | 0 / 1,744 |
| other Total, other adverse events | 0 / 6,294 | 0 / 1,744 |
| serious Total, serious adverse events | 1 / 6,294 | 0 / 1,744 |
Outcome results
Primary
The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral
The difference between intervention and control period will be calculated. Treatment at the GPC means having a record at the GPC.
Time frame: Patient flow will be followed for 24 hours after presentation at the ED
Population: See main paper for more details.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Triage With Referral to Primary Care | The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral | 599 Participants |
| Triage Without Referral to Primary Care | The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral | 0 Participants |