Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study

Slagman, Anna, Greiner, Felix, Searle, Julia, Harriss, Linton, Thompson, Fintan, Frick, Johann, Bolanaki, Myrto, Lindner, Tobias, and Möckel, Martin (2019) Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study. BMJ Open, 9. e024896.

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Abstract

Objectives: To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany.

Design: Prospective cohort study.

Setting: Single centre University Hospital Emergency Department.

Participants: Adult, non-surgical ED patients.

Exposure: A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS.

Primary and secondary outcome measures: Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality).

Results: A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n= 358) received a non-urgent triage category and 68.1% (n= 764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p= 0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher inhospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n= 4] vs 2.2% [n= 15]; p= 0.285) or for 1-year mortality (7.9% [n= 26] vs 10.5% [n= 72]; p= 0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR= 1.35; 95% CI 0.87 to 2.12; p= 0.185) and multivariate regression analyses (HR= 1.20; 95% CI 0.77 to 1.89; p= 0.420).

Conclusions: The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care.

Item ID: 60046
Item Type: Article (Research - C1)
ISSN: 2044-6055
Copyright Information: © Author(s) (or their employer(s)) 2019. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license.
Funders: Thermo Fisher Scientific
Date Deposited: 03 Jul 2019 07:47
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420305 Health and community services @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320207 Emergency medicine @ 25%
42 HEALTH SCIENCES > 4203 Health services and systems > 420304 General practice @ 25%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 50%
92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 50%
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