Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department

Abstract

Objective. To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the “right” use of emergency services, on the division of work between ED nurses and general practitioners (GPs). Design. An observational and quasi-experimental study based on before–after comparisons. Setting. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. Subjects. GPs and nurses from two different primary care EDs. Main outcome measures. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. Results. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. Conclusion. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.

A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study

“…The reason for this decrease is unknown because the population of Vantaa city increased during the follow-up (Table 1) and, according to the official Finnish statistics, the population of Vantaa aged significantly during the follow-up period. 16 A very small proportion of the patients turned to private sector GPs as the access to the EDs became difficult 11,12,17 but despite this minor bypass flow there should not have been decreased demand for office-hour GP services in Vantaa. Nevertheless, the present interventions did not seem to result in excessive workload for the office-hour GPs.…”

The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

“…Thus, in Vantaa the follow-up was performed from 1st February 2004 to 31st December 2007 after which Peijas ED moved to a new ED system (reverse triage) [ 23 ]. In Espoo (the control) the follow-up was performed from 1st February2004 to 1st April 2007, after which EDs moved gradually to a reverse triage system, which greatly altered patient flows in the local health care system [ 24 ]. Thus, we could study the situation before and after the intervention in the EDs of Vantaa and compare the changes with the situation in Espoo where no intervention was performed.…”

“…Both enumerative and statistical analytic methods were used [ 24 ]. Enumerative statistics were employed to determine whether the aggregated data from 2004, i.e.…”

“…Since the “Area X” primary care ED closure took place at the beginning of May 2005, the number of patient visits before and after the closure were compared. The numbers of monthly visits to doctors were initially compared by using one-way repeated measures analysis of variance for abolishing the effects of systematic monthly variation caused by doctors’ holidays [ 24 ]. RM-Anova was followed by the Bonferroni’s correction.…”

“…The data were also evaluated by using analytic statistical methods (i.e., to look at data changes over time), with Statistical Process Control (SPC) tools (e.g. the XmR chart) [ 24 – 26 ]. Once the intervention (closure of the ED) was put in place, the performance of the dependent variable was compared to the baseline performance (February 2004 – May 2005).…”