Patients treated by general practitioners in auniversity emergency department before and after implementation of atriage system

Abstract

In auniversity emergency department (ED), patients with low treatment urgency and general medical complaints are assigned to general practitioners within the ED. The Emergency Severity Index (ESI) was implemented to determine the urgency of treatment. To investigate the impact of the ESI implementation on the patient population treated by general practitioners and to show the distribution of ESI categories among these patients. Comparison of emergency patients treated by general practitioners over 6months before (t0) and after (t1) ESI implementation using routine data and an evaluation form to be completed by the general practitioner. The analysis was carried out descriptively and using the Χ2test and t‑test. At t0, 615 treatment cases and at t1 751cases were analyzed. There were no significant differences in age, gender, the proportion of patients being referred to ED, or hospital admissions. The ESI classification was predominantly in the low urgency categories ESI5 (37%) and ESI4 (46%), with 8% of patients in ESI3 or2. The predicted resource needs matched for 76% of patients in ESI5, for 36% in ESI4, and for 44% of patients in ESI3. Hospital admission was required for 3% of ESI 5patients and 7% of ESI 4patients. Even for patients with low treatment urgency, hospital admission may be indicated. In addition, differences from the predicted resource requirements indicate triaging problems in the patient population studied. Thus, the ESI assessment does not seem suitable to redirect patients to non-ED-based outpatient care.