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Safety and efficiency of triaging low urgent self-referred patients to a general practitioner at an acute care post: an observational study
  1. Lieke M van der Straten1,
  2. Henk F van Stel1,
  3. Frans J M Spee2,
  4. Marleen E Vreeburg3,
  5. Augustinus J P Schrijvers1,
  6. Leontien M Sturms1
  1. 1Julius Center for Health Care and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2General Practice Cooperative Nieuwegein, Nieuwegein, The Netherlands
  3. 3Emergency Department, St. Antonius Hospital, Nieuwegein, The Netherlands
  1. Correspondence to Dr Henk F van Stel, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, STR6.131, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands; h.vanstel{at}umcutrecht.nl

Abstract

Objective To assess the safety and efficiency of triaging low urgent self-referred patients at the emergency department (ED) to a general practitioner (GP) based on the Manchester triage system (MTS).

Methods All self-referred patients in the evening, night and weekends were included in this prospective observational study. Patients were triaged by an ED nurse according to the MTS and allocated to a GP or the ED according to a predefined care scheme. For patients treated by the GP, assessments were made of safety as measured by hospitalisation and return to the ED within 2 weeks, and efficiency as measured by referral to the ED.

Results In 80% of cases allocation of the self-referrals to the ED or GP was according to a predefined scheme. Of the 3129 low urgent self-referred patients triaged to the GP, 2840 (90.8%) were sent home, 202 (6.5%) were directly referred to the ED, 36 (1.2%) were hospitalised. Within a random sample of low urgent patients sent home by the GP (222 of 2840), 8 (3.6%) returned to the ED within 2 weeks. Against the agreed MTS scheme, the ED also directly treated 664 low urgent patients, mainly for extremity problems (n=512). Despite the care agreements, 227 urgent patients were treated by the GP, with a referral rate to the ED of 18.1%, a hospitalisation rate of 4.0% and a 4.5% return rate to the ED within 2 weeks.

Conclusions Low urgent self-referrals, with the exception of extremity problems, were shown to be treated efficiently and safely by a GP. A selected group of more urgent patients also seem to be handled adequately by the GP. Triage of low urgent patients with extremity problems and reasons for nurses not following a predefined triage allocation scheme need further elaboration.

  • After-hours care
  • emergency medical services
  • general practitioners
  • emergency department
  • triage
  • epidemiology
  • care systems
  • quality assurance
  • emergency department management
  • trauma
  • epidemiology

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Footnotes

  • Funding This study was supported by an unrestricted research grant from Agis Healthcare Insurance.

  • Competing interests None.

  • Ethics approval This study was approved by medical ethical committee of the University Medical Center Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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