Impact of the ABCDE triage in primary care emergency department on the number of patient visits to different parts of the health care system in Espoo City

Abstract

Background: Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care doctors are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to secondary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for urgent patients. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the EDs of Espoo City, Finland.

Methods: The numbers of monthly visits to doctors were recorded before and after intervention in Espoo primary care EDs. To study if the implementation of the triage system redirects patients to other health services, the numbers of monthly visits to doctors were also scored in the private health care, the public sector health services of Espoo primary care during office hours and local secondary health care ED (Jorvi hospital). A face-to-face triage system was applied in the primary care EDs as an attempt to provide immediate treatment for the most acute patients. It is based on the letters A (patient sent directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs. The first step was an initial patient assessment by a health care professional (triage nurse). The introduction of this triage system was combined with information to the public on the "correct" use of emergency services.

Results: After implementation of the ABCDE-triage system the number of patient visits to a primary care doctor decreased by up to 24% (962 visits/month) as compared to the three previous years in the EDs. The Number of visits to public sector GPs during office hours did not alter. Implementation of ABCDE-triage combined with public guidance was associated with decreased total number of doctor visits in public health care. During same period, the number of patient visits in the private health care increased. Simultaneously, the number of doctor visits in secondary health care ED did not alter.

Conclusions: The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the secondary health care EDs. Limiting the access of less urgent patients to ED may redirect the demands of patients to private sector rather than office hours GP services.

Figure 1

ABCDE -associated changes in numbers of monthly doctor visits in EDs of Espoo. Data are shown as one year epochs before and after triage. Mean and SE (brackets) is shown. *** means P < 0.001, Bonferroni test compared with the frequency of monthly visits in the one year epoch after beginning the ABCDE-triage.

Figure 2

ABCDE -associated changes in numbers of monthly office-hour doctor visits in Espoo. Data are shown as one year epochs before and after triage. Mean and SE (brackets) is shown.

Figure 3

ABCDE -associated changes in numbers of monthly doctor visits in public side of GPs in Espoo. Data are shown as one year epochs before and after triage. Mean and SE (brackets) is shown. *** means P < 0.001, Bonferroni test compared with the frequency of monthly visits in the one year epoch after beginning the ABCDE-triage.

Figure 4

ABCDE-associated changes in numbers of monthly doctor visits in private sector GPs in Espoo. Data are shown as one year epochs before and after triage. Mean and SE (brackets) is shown. * means P < 0.05, ** P < 0.01 and *** P < 0.001, Bonferroni test compared with the frequency of monthly visits in the one year epoch after beginning the ABCDE-triage.

Figure 5

ABCDE-associated changes in numbers of monthly visits and referrals to secondary health care in Jorvi ED. Data are shown as one year epochs before and after triage. Mean and SE (brackets) is shown.