Ill during the weekend

Ondertitel:to the general practitioner or to the emergency department?

When confronted with an illness during out-of-hours care, patients can consult primary care (organised in General Practice Cooperatives, GPCs) or an Emergency Departments (EDs). Up to 40% of those who choose the ED have complaints suitable for primary care. One solution to this problem is to help patients to make this choice by triage, a quick examination to determine the priority of need and proper place of treatment. In two precursory studies concerning 1733 telephone triage, we found that this system was not ready for implementation, telephone triage alone was not the solution. A pilot studying a campaign promoting the GPC at an ED, resulted in the save diversion of 5% of the patients from the ED to the GPC. The TRIAGE trial was an unblinded randomised controlled trial with weekends serving as clusters. The intervention was triage by a nurse using a new tool assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment while it was not communicated during control weekends (all patients remained at the ED). Out of the included patients, 9.5% were diverted to the GPC. This proportion was influenced by the reason for encounter, age of the patient, and the nurse on duty. Out of the diverted patients, 4% were referred back to the ED. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. In the intervention group, this proportion was 13%, in the control group 25%. This discrepancy was due to differences in the use of the studied tool. Using semi-structured interviews with healthcare workers we found a high enthusiasm. Risk aversion of some nurses, possible language barriers and the non-adapted ED infrastructure were the main barriers to implementation. One quarter of the patients who received an assignment to the GPC refused to comply and stayed at the ED. This proportion was influenced by the nurse on duty and the patient's socio-economic status. The intervention reduces costs for patients but slightly increased cost for the government. Overall, the intervention of the TRIAGE trial was evaluated positive, albeit some methodological limitations and a low efficiency. It helps patients to choose the most appropriate caregiver. An integrated approach which includes self- and telephone triage is required for further implementation.

Jaar van publicatie:2022

Trefwoorden:Doctoral thesis

Toegankelijkheid:Open