Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study

Prehospital telephone triage stratifies patients into five categories, "need immediate hospital visit by ambulance," "need to visit a hospital within 1 hour," "need to visit a hospital within 6 hours," "need to visit a hospital within 24 hours," and "do n...

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Published in:BMC emergency medicine 2021-12, Vol.21 (1), p.155-155, Article 155
Main Authors: Inokuchi, Ryota, Jin, Xueying, Iwagami, Masao, Abe, Toshikazu, Ishikawa, Masatoshi, Tamiya, Nanako
Format: Article
Language:English
Subjects:
After-hours house call
Age
Aged
Ambulances
Cerebral infarction
Cohort analysis
Confidence intervals
Dementia
Dementia disorders
Diabetes
Diabetes mellitus
Diabetics
Emergency department
Emergency medical care
Heart failure
Hospitals
Humans
Hypertension
Infarction
Medical records
Medical research
Medicine, Experimental
Nurses
Older people
Out-of-hours services
Patient safety
Patients
Physicians
Quality
Retrospective Studies
Statistical analysis
Telemedicine
Telephone
Telephone hotlines
Triage
Undertriage
Vital signs
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description Prehospital telephone triage stratifies patients into five categories, "need immediate hospital visit by ambulance," "need to visit a hospital within 1 hour," "need to visit a hospital within 6 hours," "need to visit a hospital within 24 hours," and "do not need a hospital visit" in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16-64, 65-74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71-3.36], 8.57 [95% CI 4.83-15.2], and 14.9 [95% CI 9.65-23.0], respectively; reference patients aged
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However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged. We included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively. We identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16-64, 65-74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71-3.36], 8.57 [95% CI 4.83-15.2], and 14.9 [95% CI 9.65-23.0], respectively; reference patients aged &lt; 15 years); those with diabetes mellitus (2.31 [95% CI 1.25-4.26]); those with dementia (2.32 [95% CI 1.05-5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01-3.87]) as more likely to be undertriaged. 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subjects After-hours house call
Age
Aged
Ambulances
Cerebral infarction
Cohort analysis
Confidence intervals
Dementia
Dementia disorders
Diabetes
Diabetes mellitus
Diabetics
Emergency department
Emergency medical care
Heart failure
Hospitals
Humans
Hypertension
Infarction
Medical records
Medical research
Medicine, Experimental
Nurses
Older people
Out-of-hours services
Patient safety
Patients
Physicians
Quality
Retrospective Studies
Statistical analysis
Telemedicine
Telephone
Telephone hotlines
Triage
Undertriage
Vital signs
title Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study
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