Julius Centre for Health Sciences and Primary Care, UMC Utrecht, 3508 GA, Utrecht, The Netherlands.
Emerg Med J. 2012 Nov;29(11):877-81. doi: 10.1136/emermed-2011-200539. Epub 2011 Dec 8.
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).
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.
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.
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.
评估基于曼彻斯特分诊系统（MTS）将急诊科（ED）低紧急度的自就诊患者分诊给全科医生（GP）的安全性和效率。
本前瞻性观察研究纳入所有晚间、夜间和周末的自就诊患者。患者由 ED 护士根据 MTS 分诊，并根据预定义的护理方案分配给 GP 或 ED。对于由 GP 治疗的患者，评估安全性（通过住院和 2 周内返回 ED 来衡量）和效率（通过转至 ED 来衡量）。
在 80%的情况下，自就诊患者的分配符合预定义方案。在分诊至 GP 的 3129 例低紧急度自就诊患者中，2840 例（90.8%）被送回家，202 例（6.5%）直接转至 ED，36 例（1.2%）住院。在 GP 送回家的低紧急度患者的随机样本中（2840 例中的 222 例），8 例（3.6%）在 2 周内返回 ED。根据商定的 MTS 方案，ED 还直接治疗了 664 例低紧急度患者，主要为四肢问题（n=512）。尽管有护理协议，但仍有 227 例紧急患者由 GP 治疗，向 ED 转诊率为 18.1%，住院率为 4.0%，2 周内返回 ED 的比例为 4.5%。
除四肢问题外，低紧急度自就诊患者由 GP 治疗效率高且安全。一个选择的更紧急患者群体似乎也由 GP 妥善处理。需要进一步阐明分诊四肢问题的低紧急度患者和护士不遵循预定义分诊分配方案的原因。
