title: Safety and efficiency of triaging low urgent self-referred patients to a general practitioner at an acute care post: an observational study.
abstract: OBJECTIVE
  To assess the safety and efficiency of triaging low urgent self-referred patients at the emergency department (ED) to a general practitioner (GP) based on the Manchester triage system (MTS).
  
  
  METHODS
  All self-referred patients in the evening, night and weekends were included in this prospective observational study. Patients were triaged by an ED nurse according to the MTS and allocated to a GP or the ED according to a predefined care scheme. For patients treated by the GP, assessments were made of safety as measured by hospitalisation and return to the ED within 2 weeks, and efficiency as measured by referral to the ED.
  
  
  RESULTS
  In 80% of cases allocation of the self-referrals to the ED or GP was according to a predefined scheme. Of the 3129 low urgent self-referred patients triaged to the GP, 2840 (90.8%) were sent home, 202 (6.5%) were directly referred to the ED, 36 (1.2%) were hospitalised. Within a random sample of low urgent patients sent home by the GP (222 of 2840), 8 (3.6%) returned to the ED within 2 weeks. Against the agreed MTS scheme, the ED also directly treated 664 low urgent patients, mainly for extremity problems (n=512). Despite the care agreements, 227 urgent patients were treated by the GP, with a referral rate to the ED of 18.1%, a hospitalisation rate of 4.0% and a 4.5% return rate to the ED within 2 weeks.
  
  
  CONCLUSIONS
  Low urgent self-referrals, with the exception of extremity problems, were shown to be treated efficiently and safely by a GP. A selected group of more urgent patients also seem to be handled adequately by the GP. Triage of low urgent patients with extremity problems and reasons for nurses not following a predefined triage allocation scheme need further elaboration.
authors.affiliation: Julius Centre for Health Sciences and Primary Care, UMC Utrecht, 3508 GA, Utrecht, The Netherlands.
authors.forename: Lieke M
authors.initials: LM
authors.lastname: van der Straten
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
authors.forename: Frans J M
authors.initials: FJ
authors.lastname: Spee
authors.forename: Marleen E
authors.initials: ME
authors.lastname: Vreeburg
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
authors.forename: Leontien M
authors.initials: LM
authors.lastname: Sturms
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration / Q000592:standards; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017598:Efficiency, Organizational / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D012648:Self Care / Q000706:statistics & numerical data*; D014218:Triage / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult