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Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study.
BMJ Open. 2017 Oct 15; 7(10):e016845.BO

Abstract

OBJECTIVE

To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage.

DESIGN

A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage.

SETTING

The 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.

POPULATION

Cases 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 MEASURES

Appropriateness 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').

RESULTS

Planned 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.

CONCLUSIONS

Secondary 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.

Authors+Show Affiliations

Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Ambulance Victoria, Melbourne, Victoria, Australia.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Ambulance Victoria, Melbourne, Victoria, Australia.Emergency Services Telecommunications Authority, Melbourne, Victoria, Australia.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Emergency Services Telecommunications Authority, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29038180

Citation

Eastwood, Kathryn, et al. "Appropriateness of Cases Presenting in the Emergency Department Following Ambulance Service Secondary Telephone Triage: a Retrospective Cohort Study." BMJ Open, vol. 7, no. 10, 2017, pp. e016845.
Eastwood K, Smith K, Morgans A, et al. Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study. BMJ Open. 2017;7(10):e016845.
Eastwood, K., Smith, K., Morgans, A., & Stoelwinder, J. (2017). Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study. BMJ Open, 7(10), e016845. https://doi.org/10.1136/bmjopen-2017-016845
Eastwood K, et al. Appropriateness of Cases Presenting in the Emergency Department Following Ambulance Service Secondary Telephone Triage: a Retrospective Cohort Study. BMJ Open. 2017 Oct 15;7(10):e016845. PubMed PMID: 29038180.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study. AU - Eastwood,Kathryn, AU - Smith,Karen, AU - Morgans,Amee, AU - Stoelwinder,Johannes, Y1 - 2017/10/15/ PY - 2017/10/18/entrez PY - 2017/10/19/pubmed PY - 2018/6/13/medline KW - health services misuse KW - health services needs and demand KW - referral and consultation KW - telephone KW - triage SP - e016845 EP - e016845 JF - BMJ open JO - BMJ Open VL - 7 IS - 10 N2 - OBJECTIVE: To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. DESIGN: A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. SETTING: The 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. POPULATION: Cases 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 MEASURES: Appropriateness 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'). RESULTS: Planned 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. CONCLUSIONS: Secondary 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. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/29038180/Appropriateness_of_cases_presenting_in_the_emergency_department_following_ambulance_service_secondary_telephone_triage:_a_retrospective_cohort_study_ L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=29038180 DB - PRIME DP - Unbound Medicine ER -