Triaging and Referring in Adjacent General and Emergency Departments

Not Applicable

Completed

Conditions: Triage

Interventions: Other: Usual care
Other: Triage with referral to primary care

Registration Number: NCT03793972

Lead Sponsor: Universiteit Antwerpen

Brief Summary: Introduction: Patients who might also go to the general practitioner (GP) frequently consult emergency departments (ED). This leads to additional costs for both government and patient and a high workload for emergency physicians in Flanders. The Belgian government wants to address this problem by improved collaboration between EDs and general practice cooperatives (GPCs).

Intervention: Patients presenting at the ED during out-of-hours (OOH) will be triaged and allocated to the most appropriate service. For this purpose the Manchester Triage System (MTS) which is commonly used in Flemish hospitals, will be extended (eMTS). By doing so a trained nurse will be able to diverge suitable patients towards the GPC.

Methodology: The investigators will conduct a cluster randomised controlled trial in which eligible ED patients will be diverged to the GPC using the eMTS. The investigators will collect data using the iCAREdata database. The investigators will study the use of the eMTS, the effectiveness and effects of triage, work load changes, epidemiology at both departments, patient safety, health insurance (HIS) and patient expenditures. Furthermore, facilitators and barriers will be studied and an incident analysis of problem cases will be performed.

Outcome: The primary outcome is the proportion of patients who enter the ED and are handled by the GP after triage. Secondary outcome measurements are related to safety: referral rate to the ED by the GP, proportion of patients not following the triage advice and file review for selected patients.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 8158

Inclusion Criteria

availability of a Belgian citizen national insurance number

Exclusion Criteria

Patients arriving at the ED by an ambulance with a doctor or nurse
Patients all ready admitted to an other hospital department

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Triage without referral to primary care	Usual care	Weekends with usual care
Triage with referral to primary care	Triage with referral to primary care	Triage and referral according to eMTS.

Primary Outcome Measures

Name	Time	Method
The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral	Patient flow will be followed for 24 hours after presentation at the ED	The difference between intervention and control period will be calculated. Treatment at the GPC means having a record at the GPC.

Secondary Outcome Measures