Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial

<h4>Objectives</h4> To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). <h4>Methods</h4> Unblinded randomised controlled trial with weekends serving as clusters (three interven...

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Autores principales:	Stefan Morreel, Hilde Philips, Diana De Graeve, Koenraad G. Monsieurs, Jarl K. Kampen, Jasmine Meysman, Eva Lefevre, Veronique Verhoeven
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/bfee744122b34784a5a211fa91c4c6c1
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spelling	oai:doaj.org-article:bfee744122b34784a5a211fa91c4c6c12021-11-11T06:44:15ZTriaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial1932-6203https://doaj.org/article/bfee744122b34784a5a211fa91c4c6c12021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565772/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4> To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). <h4>Methods</h4> Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). <h4>Results</h4> In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. <h4>Conclusions</h4> ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. <h4>Trial registration</h4> ClinicalTrials.gov Identifier: NCT03793972Stefan MorreelHilde PhilipsDiana De GraeveKoenraad G. MonsieursJarl K. KampenJasmine MeysmanEva LefevreVeronique VerhoevenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stefan Morreel Hilde Philips Diana De Graeve Koenraad G. Monsieurs Jarl K. Kampen Jasmine Meysman Eva Lefevre Veronique Verhoeven Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
description	<h4>Objectives</h4> To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). <h4>Methods</h4> Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). <h4>Results</h4> In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. <h4>Conclusions</h4> ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. <h4>Trial registration</h4> ClinicalTrials.gov Identifier: NCT03793972
format	article
author	Stefan Morreel Hilde Philips Diana De Graeve Koenraad G. Monsieurs Jarl K. Kampen Jasmine Meysman Eva Lefevre Veronique Verhoeven
author_facet	Stefan Morreel Hilde Philips Diana De Graeve Koenraad G. Monsieurs Jarl K. Kampen Jasmine Meysman Eva Lefevre Veronique Verhoeven
author_sort	Stefan Morreel
title	Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
title_short	Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
title_full	Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
title_fullStr	Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
title_full_unstemmed	Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial
title_sort	triaging and referring in adjacent general and emergency departments (the triage trial): a cluster randomised controlled trial
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/bfee744122b34784a5a211fa91c4c6c1
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Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial

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