Acta Clin Belg. 2022 Apr;77(2):301-306. doi: 10.1080/17843286.2020.1839719. Epub 2020 Oct 30.
Patients in Belgium needing out-of-hours medical care have two options: the emergency department (ED) or a general practitioner (GP) on call. Currently, there is no triage system in Belgium, so patients do not know where they should go. However, patients who could be managed by a GP frequently present themselves at an ED without referral. GPs often organise themselves in a General Practitioners Cooperative (GPC). This study assesses the accuracy of a newly developed telephone triage guideline.
Observational real-time simulation: all walk-in patients at two GPCs and three EDs were asked to call a triage telephone number with their current medical problem. The operator handling this call registered an urgency level and a resource (ED, GP or ambulance) to deploy. The treating physician's opinion was used a the gold standard for correct triage. Patients were not informed about the outcome of the triage and continued the standard care path they had chosen.
The overall sensitivity of the telephone triage for detecting patients who could be managed by a GP was 82% with a specificity of 53%. The correctness of the advice given by the operator according to the physicians was 71%, with 12% underestimation of urgency and 17% overestimation. At the GPC, the sensitivity for detecting patients requiring GP management/care was 91% with a specificity of 36%. At the ED, the sensitivity for detecting GP patients was 67% with a specificity of 48%.
This study evaluates a new guideline for telephone triage, showing potential overtriage for patients wanting to attend the GPC, with possible inefficiency, and potential undertriage for patients wanting to attend the ED, with possible safety issues.
在比利时，需要非工作时间医疗护理的患者有两种选择：急诊部（ED）或值班的全科医生（GP）。目前，比利时没有分诊系统，因此患者不知道应该去哪里。然而，那些可以由 GP 管理的患者经常在没有转诊的情况下到 ED 就诊。GP 通常在全科医生合作社（GPC）中组织自己。本研究评估了新开发的电话分诊指南的准确性。
观察性实时模拟：两个 GPC 和三个 ED 的所有门诊患者都被要求拨打分诊电话，告知他们当前的医疗问题。处理此电话的操作员会记录紧急程度和部署的资源（ED、GP 或救护车）。主治医生的意见被用作正确分诊的金标准。患者不知道分诊的结果，并继续选择他们选择的标准护理路径。
电话分诊对检测可以由 GP 管理的患者的总体敏感性为 82%，特异性为 53%。根据医生的意见，操作员给出的建议的正确性为 71%，其中 12%低估了紧急程度，17%高估了紧急程度。在 GPC，检测需要 GP 管理/护理的患者的敏感性为 91%，特异性为 36%。在 ED，检测需要 GP 患者的敏感性为 67%，特异性为 48%。
本研究评估了一种新的电话分诊指南，显示出对希望到 GPC 就诊的患者可能存在过度分诊，可能存在效率低下的问题，对希望到 ED 就诊的患者可能存在分诊不足，可能存在安全问题。
