Factors associated with undertriage in patients classified by the need to visit a hospital by telephone triage: a retrospective cohort study

Ryota Inokuchi,Xueying Jin,Nanako Tamiya,Masao Iwagami,Masatoshi Ishikawa,Toshikazu Abe

doi:10.1186/s12873-021-00552-x

Abstract

BackgroundPrehospital telephone triage stratifies patients into five categories, “need immediate hospital visit by ambulance,” “need to visit a hospital within 1 hour,” “need to visit a hospital within 6 hours,” “need to visit a hospital within 24 hours,” and “do not need a hospital visit” in Japan. However, studies on whether present and past histories cause undertriage are limited in patients triaged as need an early hospital visit. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged.MethodsWe included all patients classified by telephone triage as need to visit a hospital within 1 h and 6 h who used a single after-hours house call (AHHC) medical service in Tokyo, Japan, between November 1, 2019, and November 31, 2020. After home consultation, AHHC doctors classified patients as grade 1 (treatable with over-the-counter medications), 2 (requires hospital or clinic visit), or 3 (requires ambulance transportation). Patients classified as grade 2 and 3 were defined as appropriately triaged and undertriaged, respectively.ResultsWe identified 10,742 eligible patients triaged as need to visit a hospital within 1 h and 6 h, including 10,479 (97.6%) appropriately triaged and 263 (2.4%) undertriaged patients. Multivariable logistic regression analyses revealed patients aged 16–64, 65–74, and ≥ 75 years (adjusted odds ratio [OR], 2.40 [95% confidence interval {CI} 1.71–3.36], 8.57 [95% CI 4.83–15.2], and 14.9 [95% CI 9.65–23.0], respectively; reference patients aged < 15 years); those with diabetes mellitus (2.31 [95% CI 1.25–4.26]); those with dementia (2.32 [95% CI 1.05–5.10]); and those with a history of cerebral infarction (1.98 [95% CI 1.01–3.87]) as more likely to be undertriaged.ConclusionsWe found that older adults and patients with diabetes mellitus, dementia, or a history of cerebral infarction were at risk of undertriage in patients triaged as need to visit a hospital within 1 h and 6 h, but further studies are needed to validate these findings.

Highlights

Prehospital telephone triage systems identify the appropriate care required for patients and determine their need for a hospital visit or an immediate hospital visit by ambulance [1]
The proportions of patients aged 65–74 and ≥ 75 years were higher in the undertriaged group than in the appropriately triaged group
The proportion of patients with hypertension, diabetes mellitus, hyperlipidemia, gout, heart failure, cerebral infarction, cancer, and dementia was higher in the undertriaged group than in the appropriately triaged group

Summary

Introduction

Background Prehospital telephone triage systems identify the appropriate care required for patients and determine their need for a hospital visit or an immediate hospital visit by ambulance [1]. In Japan, the Fire and Disaster Management Agency developed telephone triage protocols and established telephone consultation centers in several large cities, including Tokyo, to provide telephone triage to patients [5]. A private AHHC service was established in Tokyo, Japan This service provides consultations through telephone triages using developed telephone triage protocols. These protocols classify patients into five categories: “need immediate hospital visit by ambulance (red),” “need to visit a hospital within 1 hour (orange),” “need to visit a hospital within 6 hours (yellow),” “need to visit a hospital within 24 hours (green),” and “do not need a hospital visit (white).”. We investigated factors associated with undertriage by comparing patient assessed to be appropriately triaged with those assessed undertriaged

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Methods

Results