Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial
Objectives In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the int...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-07-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e059173.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832576597731835904 |
|---|---|
| author | Hilde Philips Veronique Verhoeven Stefan Morreel Jasmine Meysman Ines Homburg Diana De Graeve KG Monsieurs |
| author_facet | Hilde Philips Veronique Verhoeven Stefan Morreel Jasmine Meysman Ines Homburg Diana De Graeve KG Monsieurs |
| author_sort | Hilde Philips |
| collection | DOAJ |
| description | Objectives In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC.Setting ED of a general hospital and the adjacent GPC.Participants 8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations.Results An additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01).Conclusion Nurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients.Trial registration number NCT03793972. |
| format | Article |
| id | doaj-art-10ca5408fc86484990bd147497a30b4a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-10ca5408fc86484990bd147497a30b4a2025-01-31T02:40:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-059173Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trialHilde Philips0Veronique Verhoeven1Stefan Morreel2Jasmine Meysman3Ines Homburg4Diana De Graeve5KG Monsieurs6Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, BelgiumDepartment of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, BelgiumDepartment of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, BelgiumDepartment of Economics, University of Antwerp, Antwerpen, BelgiumDepartment of Economics, University of Antwerp, Antwerpen, BelgiumDepartment of Economics, University of Antwerp, Antwerpen, BelgiumEmergency Department, Universitair Ziekenhuis Antwerpen, Edegem, BelgiumObjectives In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC.Setting ED of a general hospital and the adjacent GPC.Participants 8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations.Results An additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01).Conclusion Nurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients.Trial registration number NCT03793972.https://bmjopen.bmj.com/content/12/7/e059173.full |
| spellingShingle | Hilde Philips Veronique Verhoeven Stefan Morreel Jasmine Meysman Ines Homburg Diana De Graeve KG Monsieurs Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial BMJ Open |
| title | Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial |
| title_full | Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial |
| title_fullStr | Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial |
| title_full_unstemmed | Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial |
| title_short | Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial |
| title_sort | differences in emergency nurse triage between a simulated setting and the real world post hoc analysis of a cluster randomised trial |
| url | https://bmjopen.bmj.com/content/12/7/e059173.full |
| work_keys_str_mv | AT hildephilips differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT veroniqueverhoeven differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT stefanmorreel differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT jasminemeysman differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT ineshomburg differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT dianadegraeve differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial AT kgmonsieurs differencesinemergencynursetriagebetweenasimulatedsettingandtherealworldposthocanalysisofaclusterrandomisedtrial |