Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium.
BMJ Open. 2022 Jul 1;12(7):e059173. doi: 10.1136/bmjopen-2021-059173.
In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC.
ED of a general hospital and the adjacent GPC.
8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations.
An additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01).
Nurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients.
NCT03793972.
在 TRIAGE 试验中，一项使用曼彻斯特分诊系统新扩展部分将急诊科（ED）患者分诊至全科医生合作诊所（GPC）的整群随机试验中，干预组和对照组之间分配至 GPC 的患者比例差异显著：干预组为 13.3%（鼓励患者遵守 ED 或 GPC 分配，实际情况），对照组为 24.7%（未传达分配，所有患者均留在 ED，模拟情况）。在这项二次分析中，我们评估了干预组和对照组之间分诊工具使用的差异，以及分配至 GPC 的患者的成本和住院情况的差异。
综合医院的 ED 和相邻的 GPC。
8038 名患者（6294 名干预组和 1744 名对照组）。
分诊参数（就诊原因、鉴别器和紧急类别）导致分配至 ED 的患者比例、计算机生成的 GPC 分配被否决的患者比例、选择某些参数的动机、成本（发票）和住院情况。
干预组中额外有 3.1%（p<0.01）的患者被归类为紧急。导致 ED 的鉴别器增加了 16.2%（p<0.01），主要是因为需要进行影像学检查。护士同样选择了流向 ED 的流程图（p=0.41），并同样否决了方案（p=0.91）。在干预组中，分配至 GPC 的患者的平均成本降低了 23 欧元（p<0.01），分配至 GPC 的患者住院人数减少（1.0%比 1.6%，p<0.01）。
与理论上分配到初级保健相比，当使用分诊工具将患者分诊到初级保健时，护士使用的分诊工具更具风险规避性。模拟环境的结果不应推断至实际患者。
NCT03793972。
