Changes of triage by GPs during the course of prehospital emergency situations in a Norwegian rural community

Abstract

BackgroundPriority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage.MethodsIn the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (2005–2007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient.Results236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages.ConclusionsIn pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases.

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“…The present finding that 'gastrointestinal' was the most common clinical presentation in this patient group matches prehospital triage research showing that 'acute abdominal' cases had the highest chance of being initially 'undertriaged' by telephone, and then upgraded to more severe on face-toface assessment. 13…”

Dispatch guideline adherence and response interval—a study of emergency medical calls in Norway

“…A similar finding of 4.6 % undertriage was found in Switzerland in a study published in 2015 [ 14 ]. In Norway, experiences of general practitioners (GPs) participating in prehospital emergency situations show that 42 % of the patients are downgraded between initial dispatch centre triaging and on-the-scene triaging by a GP, while 11 % were upgraded, acute abdominal cases having the highest risk of being initially undertriaged [ 15 ].…”