ObjectiveReverse triage means that patients who are not considered to be in need of medical services are not placed on the doctor’s list in an emergency department (ED) but are sent, after face-to-face evaluation by a triage nurse, to a more appropriate health care unit. It is not known how an abrupt application of such reverse triage in a combined primary care ED alters the demand for doctors’ services in collaborative parts of the health care system.DesignAn observational study.SettingRegister-based retrospective quasi-experimental longitudinal follow-up study based on a before–after setting in a Finnish city.SubjectsPatients who consulted different doctors in a local health care unit.Main outcome measuresNumbers of monthly visits to different doctor groups in public and private primary care, and numbers of monthly referrals to secondary care ED from different sources of primary care were recorded before and after abrupt implementation of the reverse triage.ResultsThe beginning of reverse triage decreased the number of patient visits to a primary ED doctor without increasing mortality. Simultaneously, there was an increase in doctor visits in the adjacent secondary care ED and local private sector. The number of patients who came to secondary care ED without a referral or with a referral from the private sector increased.ConclusionsThe data suggested that the reverse triage causes redistribution of the use of doctors’ services rather than a true decrease in the use of these services.

Removing a laboratory test from a computerized laboratory test order form may significantly reduce GPs' use of the laboratory test. Further studies are needed, however, to ensure the safety of this type of intervention.