Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial

• Published in: BMJ open 2022-07, Vol.12 (7), p.e059173-e059173
• Main Authors: Morreel, Stefan, Verhoeven, Veronique, Philips, Hilde, Meysman, Jasmine, Homburg, Ines, De Graeve, Diana, Monsieurs, KG
• Format: Article
• Language: English
• Subjects: Abdomen; accident & emergency medicine; Classification; Costs; Efficiency; Emergency medical care; Emergency Medicine; Financial analysis; Holidays & special occasions; Nurses; organisation of health services; Pain; Patients; Primary care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-059173

ObjectivesIn 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.SettingED of a general hospital and the adjacent GPC.Participants8038 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.ResultsAn additional 3.1% (p