Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

Abstract

ObjectiveTo investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.DesignA pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage.SettingThe secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number.PopulationCases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways.Main outcome measuresAppropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’).ResultsPlanned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital.ConclusionsSecondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways.

What constitutes an emergency ambulance call?

“…The Australian Institute for Primary Care found only 25% of the growth in emergency services use can be attributed to the ageing population, and that factors such as social isolation, general practitioner (GP) unavailability and increased health awareness are influencing ambulance utilisation (2). Ambulance crews detained with non-urgent requests are unavailable should life-threatening emergencies occur (1), potentially compromising patient outcomes (4). Increased ambulance use contributes to overcrowded emergency departments (EDs), which in turn places strain on ambulance providers and the finite resources of EDs (2).…”

Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service

“…Investigating ED appropriate care for these cohorts enabled a comparative view of TTAS's influence toward clinically safe and efficient care. Consistent with previous reporting of ED appropriate care and recognizing the high prevalence of readmission in Australia, attendance was assessed as appropriate when patients were: triaged into categories 1, 2, or 3, admitted to hospital, or had been admitted recently.…”

Aligning ambulance dispatch priority to patient acuity: A methodology

“…However, previous work from our setting suggested that secondary triage appropriately identifies ED-suitable cases, and that most cases referred to alternative services do not subsequently present to the ED. 24 Finally, this methodology does not overcome non-modifiable factors that challenge the provision of a timely EMS response, such as increasing traffic congestion.…”