Brasseur Edmond, Gilbert Allison, Donneau Anne-Françoise, Monseur Justine, Ghuysen Alexandre, D'Orio Vincent
Emergency Department, University Hospital Center of Liège, Liège, Belgium.
Biostatistics Unit, University of Liège, Liège, Belgium.
Acta Clin Belg. 2022 Jun;77(3):640-646. doi: 10.1080/17843286.2021.1936353. Epub 2021 Jun 3.
Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings.
In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered.
10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively.
SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.
由于基层医疗医生持续短缺且工作量大幅增加，非工作时间基层医疗呼叫的组织已成为日常挑战。SALOMON算法是一种原创的护士电话分诊工具，可根据患者病情将其分配到最佳护理级别。本研究评估了其在实际环境中的可靠性和标准效度。
在这项为期5年的研究中，非工作时间的基层医疗呼叫被分为四类：紧急医疗服务干预（EMSI）、急诊科转诊会诊（EDRC）、基层医疗医生家访（PCPH）和基层医疗医生延迟就诊（PCPD）。我们纳入了患者分诊类别、资源和目的地的数据。如果基层医疗队列中的患者必须被转至急诊科（ED），则被归类为分诊不足。如果ED队列中的患者不需要至少三项诊断资源、一项特定于急诊的治疗或任何住院治疗，则被视为分诊过度。在ED队列中，仅考虑大学医院的患者。
使用SALOMON工具对10207次呼叫进行了分诊：19.2%被归类为EMSI，15.8%为EDRC，62.8%为PCPH，2.2%为PCPD。85.5%的呼叫分诊恰当，分诊过度率为14.5%。在PCPD/PCPH队列中，96.9%的呼叫被准确分诊，3.1%为分诊不足。SALOMON的敏感性和特异性分别达到76.6%和98.3%。
SALOMON算法是一种有效的分诊工具，有可能改善非工作时间基层医疗工作的组织。
