https://doi.org/10.4081/ecj.2024.11904
Is it possible to safely increase the number of patients classified as non-urgent in triage? A prospective observational study
Submitted: 2 October 2023
Accepted: 11 December 2023
Published: 19 January 2024
Accepted: 11 December 2023
Abstract Views: 1455
PDF: 427
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Triage systems, calibrated to discriminate acute conditions, seem unable to deal with minor non-urgent conditions. The aim of the present study to verify whether some level 4 priority codes can be safely declassified to level 5 priority codes. A prospective observational study was performed between 1° October 2022 to 31° March 2023. All patients with a code 5 according to the Manchester Triage System (MTS) were compared with patients with a priority level 4 code but with a general indicator that was downgraded to a code 5 after the triage nurse's assessment. Of the 2032 patients enrolled, 58.6% were part of the 'blue from MTS' group while 41.4% were part of the 'blue after re-evaluation' group. There was no statistical difference in the rate of hospitalisation and discharge between the two groups (p=0.928). There was also no difference between the two groups in the comparisons of short- and medium-term death. This study highlights the need to rethink strategies to declassify patients through MTS, especially given the continuous increase of non-urgent patients presenting in the ED.
Tang N, Stein J, Hsia RY, et al. Trends and characteristics of US emergency department visits, 1997-2007. JAMA 2010;304:664-70.
DOI: https://doi.org/10.1001/jama.2010.1112
Bardelli P, Kaplan V. Non-urgent encounters in a Swiss medical emergency unit. Swiss Med Wkly 2013;143:w13760.
DOI: https://doi.org/10.4414/smw.2013.13760
Morley C, Unwin M, Peterson GM, et al. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018;13:e0203316.
DOI: https://doi.org/10.1371/journal.pone.0203316
Gonçalves-Bradley D, Khangura JK, Flodgren G, et al. Primary care professionals providing non-urgent care in hospital emergency departments. Cochrane Database Syst Rev 2018;2:CD002097.
DOI: https://doi.org/10.1002/14651858.CD002097.pub4
Gräff I, Goldschmidt B, Glien P, et al. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability. PLoS One 2014;9:e88995.
Kemp K, Alakare J, Kätkä M, et al. Accuracy of Emergency Severity Index in older adults. Eur J Emerg Med 2022;29:204-9.
DOI: https://doi.org/10.1097/MEJ.0000000000000900
Zaboli A, Sibilio S, Cipriano A, et al. Italian validation of the Manchester Triage System towards short-term mortality: a prospective observational study. Emerg Care J 2023;19:11443
DOI: https://doi.org/10.4081/ecj.2023.11443
Hinson JS, Martinez DA, Cabral S, et al. Triage Performance in Emergency Medicine: A Systematic Review. Ann Emerg Med 2019;74:140-52.
DOI: https://doi.org/10.1016/j.annemergmed.2018.09.022
Zaboli A, Ausserhofer D, Pfeifer N, et al. Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system's validity. J Clin Nurs 2021;30:942-51.
DOI: https://doi.org/10.1111/jocn.15635
Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the Emergency Department Assessment of Chest Pain Score on the Triage Performance in Patients With Chest Pain. Am J Cardiol 2021;161:12-8.
DOI: https://doi.org/10.1016/j.amjcard.2021.08.058
Mackway-Jones K, Marsden J, Windle J. Manchester Triage System. Zanichelli; 2017.
Grosgurin O, Cramer B, Schaller M, et al. Patients leaving the emergency department without being seen by a physician: a retrospective database analysis. Swiss Med Wkly 2013;143:w13889.
DOI: https://doi.org/10.4414/smw.2013.13889
Tam HL, Chung SF, Lou CK. A review of triage accuracy and future direction. BMC Emerg Med 2018;18:58.
DOI: https://doi.org/10.1186/s12873-018-0215-0
Goodridge D, Stempien J. Understanding why older adults choose to seek non-urgent care in the emergency department: the patient's perspective. CJEM 2019;21:243-8.
DOI: https://doi.org/10.1017/cem.2018.378
Lowthian JA, Smith C, Stoelwinder JU, et al. Why older patients of lower clinical urgency choose to attend the emergency department. Intern Med J 2013;43:59-65.
DOI: https://doi.org/10.1111/j.1445-5994.2012.02842.x
Bahadori M, Mousavi SM, Teymourzadeh E, et al. Non-urgent visits to emergency departments: a qualitative study in Iran exploring causes, consequences and solutions. BMJ Open 2020;10:e028257.
DOI: https://doi.org/10.1136/bmjopen-2018-028257
Gilbert A, Brasseur E, Petit M, et al. Advanced triage to redirect non-urgent Emergency Department visits to alternative care centers: the PERSEE algorithm. Acta Clin Belg 2022;77:571-8.
DOI: https://doi.org/10.1080/17843286.2021.1914948
Uthman OA, Walker C, Lahiri S, et al. General practitioners providing non-urgent care in emergency department: a natural experiment. BMJ Open 2018;8:e019736.
DOI: https://doi.org/10.1136/bmjopen-2017-019736
Gräff I, Latzel B, Glien P, et al. Validity of the Manchester Triage System in emergency patients receiving life-saving intervention or acute medical treatment-A prospective observational study in the emergency department. J Eval Clin Pract 2019;25:398-403.
DOI: https://doi.org/10.1111/jep.13030
Platts-Mills TF, Travers D, Biese K, et al. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med 2010;17:238-43.
DOI: https://doi.org/10.1111/j.1553-2712.2010.00670.x
Zaboli A, Ausserhofer D, Sibilio S, et al. Nurse triage accuracy in the evaluation of syncope according to European Society of Cardiology guidelines. Eur J Cardiovasc Nurs 2022;21:280-6.
DOI: https://doi.org/10.1093/eurjcn/zvab063
Parenti N, Reggiani ML, Iannone P, et al. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud 2014;51:1062-9.
DOI: https://doi.org/10.1016/j.ijnurstu.2014.01.013
Chen W, Linthicum B, Argon NT, et al. The effects of emergency department crowding on triage and hospital admission decisions. Am J Emerg Med 2020;38:774-9.
DOI: https://doi.org/10.1016/j.ajem.2019.06.039
Mackway-Jones K, Marsden J, Windle J. Emergency triage: Manchester Triage Group, Third edition. John Wiley & Sons, Ltd, West Sussex; 2014.
DOI: https://doi.org/10.1002/9781118299029
Brutschin V, Kogej M, Schacher S, et al. The presentational flow chart "unwell adult" of the Manchester Triage System-Curse or blessing? PLoS On 2021;16:e0252730.
DOI: https://doi.org/10.1371/journal.pone.0252730
Christ M, Grossmann F, Winter D, et al. Modern triage in the emergency department. Dtsch Arztebl Int 2010;107:892-8.
DOI: https://doi.org/10.3238/arztebl.2010.0892
Zachariasse JM, van der Hagen V, Seiger N, et al. Performance of triage systems in emergency care: a systematic review and meta-analysis. BMJ Open 2019;9:e026471.
DOI: https://doi.org/10.1136/bmjopen-2018-026471
Gräff I, Goldschmidt B, Glien P, et al. The German Version of the Manchester Triage System and its quality criteria--first assessment of validity and reliability. PLoS One 2014;9:e88995.
DOI: https://doi.org/10.1371/journal.pone.0088995
How to Cite
Zaboli, A., Sibilio, S., Mian, M., Brigo, F., & Turcato, G. (2024). Is it possible to safely increase the number of patients classified as non-urgent in triage? A prospective observational study. Emergency Care Journal, 20(1). https://doi.org/10.4081/ecj.2024.11904
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
