City of Vantaa, Finland.
BMC Emerg Med. 2010 Jun 3;10:12. doi: 10.1186/1471-227X-10-12.
Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for those patients who need it the most.
A face-to-face triage system based on the letters A (patient directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital) as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse). If the patient was not considered to be in need of immediate care (i.e. A-D) he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo). To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public office hour services of Vantaa primary care.
The number of patient visits to a primary care doctor in 2004 decreased by up to eight percent (340 visits/month) as compared to the previous year in the Peijas ED after implementation of the ABCDE-triage system. Simultaneously, doctor visits in tertiary health care ED increased by ten percent (125 visits/month). ABCDE-triage was not associated with a subsequent increase in the number of patient visits in the private health care or office hour services. The number of ED visits in the City of Espoo, used as a control where no triage was applied, remained unchanged.
The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the tertiary health care EDs.
许多芬兰急诊部门（ED）既为初级保健患者，也为二级和三级保健患者提供服务，因此被称为综合性急诊部门。初级保健专家负责进行初步评估和治疗。他们还负责规范转诊和获得三级保健服务的途径。初级保健 ED 方便公众就诊，导致非急症患者到急诊就诊。这导致排队时间延长，为最需要即时治疗的患者提供治疗变得更加困难。
芬兰万塔市（Peijas 医院）的主要急诊部门应用了一种基于字母 A（患者直接转至二级保健）、B（10 分钟内检查）、C（1 小时内检查）、D（2 小时内检查）和 E（无需立即治疗）的面对面分诊系统，尝试为最急性的患者提供即时治疗。该系统的第一步是由医疗保健专业人员（分诊护士）对患者进行初步评估。如果患者被认为不需要即时护理（即 A-D），则将其分配到 E 组，并在治疗更紧急的患者后进行检查。该分诊系统的引入与向公众宣传“正确”使用急救服务相结合。本研究的主要目的是评估在综合性 ED 中实施 ABCDE 分诊系统是否改变了患者的流动情况。为了研究干预对患者流量的影响，在干预前和干预后 Peijas ED 和同时在控制 ED（万塔的 Myyrmäki、埃斯波的 Jorvi 和 Puolarmetsä）记录每月就诊医生的次数。为了研究分诊系统的实施是否将患者转至其他卫生服务，还在万塔初级保健的私人保健和公共办公时间服务中记录了每月就诊医生的次数。
在实施 ABCDE 分诊系统后，Peijas ED 2004 年每月就诊医生的次数减少了多达 8%（340 次/月），而前一年则减少了。同时，三级保健 ED 的就诊次数增加了 10%（125 次/月）。ABCDE 分诊与私人保健或办公时间服务中患者就诊次数的随后增加无关。埃斯波市的急诊就诊次数保持不变，该市未采用分诊系统。
目前的 ABCDE 分诊系统结合公众指导可能会减少初级保健 ED 的就诊次数，但不会减少三级保健 ED 的就诊次数。
