Abstract
BackgroundPriority grade assessment according to urgency level of the patients (triage) is considered vital in emergency medicine casualties. Little is known of the experiences of pre-hospital emergency medicine triage performed by General Practitioners (GPs) in the community. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage.MethodsIn the island municipality of Austevoll, Western Norway, where the GPs and the ambulance services both take part in all medical emergency cases, all these cases were recorded during a 2-year period (2005–2007). We compared the triage of the patients at the stage of the telephone reception of the incident, and the subsequent revision of the triage at the first personal examination of the patient.Results236 emergency medical events were recorded, comprising 240 patients. Of these, 42% were downgraded between the stages (i.e. initially overtriaged), 11% were upgraded (i.e. initially undertriaged) and 47% remained in unchanged priority group. Of the diagnostic groups, acute abdominal cases had the highest probability of being upgraded between stages, while the aggregated diagnostic group of syncopes, seizures, intoxications and traumas had the highest probability of being downgraded. The principal reason for upgrading was lack of necessary information at the stage of call. In a minority of cases the upgrading was due to real patient deterioration between stages.ConclusionsIn pre-hospital triage of emergency patients, downgrading happens between notification of events and actual patient examination in a substantial proportion. Upgradings of cases are considerably fewer, but the potential serious implications of upgrading warrants individual scrutiny of such cases.
Highlights
Dispatch guidelines, urgency assessment and clinical triage have long been applied in the health services in order to prioritize among patients with acute serious illness or injury [1]
In most Western countries different formal guidelines, algorithms or triage systems have been implemented in emergency medical communication centers (EMCCs) receiving medical emergency
We examined the changes of priority grade according to diagnostic group, age and sex, and other factors
Summary
Urgency assessment and clinical triage have long been applied in the health services in order to prioritize among patients with acute serious illness or injury [1]. Such systems usually give priority to patients according to fulfillment of predefined anamnestic criteria and clinical signs. Pre-hospital triage of emergency patients is necessarily an inexact process and some degree of overtriage must generally be accepted [5] This means that patients may be approached by higher speed and more personnel than needed, subsequently determined to have less severe illness or injury, being downgraded. In this study we bring such experiences from a Norwegian island community, with special emphasis on over- and undertriage
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