title: [Impact of the referral letter on triage decisions in adult patients admitted to the emergency department].
abstract: BACKGROUND
  We conducted a two-month prospective study (8,171 admissions) in the Angers university hospital emergency room to analyse the impact of the referral letter on the initial triage of patients admitted to the emergency room performed by the reception and triage nurse.
  
  
  METHODS
  We analysed the level of priority of the CIMU triage scale (nurse's classification of emergency room patients), the presenting complaint, and the need for an urgent procedure before and after reading the referral letter and examined the nurse's comments for explanations concerning any triage changes.
  
  
  RESULTS
  1,516 patients arriving with a referral letter (18.5% of admissions) were included and interpretable data were available for 756 of these cases. After reading the referral letter, nurses modified the CIMU triage level for 34 (4.5%) patients, the presenting complaint for 50 (6.6%) patients and eliminated the need for an urgent procedure for 70 (9.3%) patients. No significant difference was observed concerning the choice of the CIMU triage level (p = 0.908). However, changes in triage level were significantly more frequently towards a more urgent category (p = 0.005). Analysis of the nurse's comments showed that these results can be explained by the signs of severity indicated in the referral letter. Certain histories and/or diagnostic hypotheses appeared to lead nurses to eliminate the need for an urgent procedure.
  
  
  CONCLUSIONS
  In this study, the referring physician's letter had a limited impact on the choice of triage level defined by the nurse on admission to the emergency room except for patients in whom the referral letter mentioned signs of severity, not observed at reception, led the nurse to apply a more urgent triage level. It would be interesting to study the information contained in the referral letter, useful for triage of patients admitted to the emergency room, in order to improve the impact of the referral letter on the quality of triage.
authors.affiliation: Département de médecine générale, UFR Médecine, 49045 Angers cedex 1.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.affiliation: Service d'accueil des urgences, CHU Angers, 49933 Angers cedex 09.
authors.forename: Betty
authors.initials: B
authors.lastname: Mazet-Guillaume
authors.affiliation: Département de médecine générale, UFR Médecine, 49045 Angers cedex 1.
authors.forename: Céline
authors.initials: C
authors.lastname: Baron
authors.affiliation: Service d'accueil des urgences, CHU Angers, 49933 Angers cedex 09.
authors.forename: Pierre Marie
authors.initials: PM
authors.lastname: Roy
authors.affiliation: Département Universitaire de Santé Publique, UFR médecine, 49045 Angers cedex 1.
authors.forename: Maurice
authors.initials: M
authors.lastname: Tanguy
authors.affiliation: Département Universitaire de Santé Publique, UFR médecine, 49045 Angers cedex 1.
authors.forename: Serge
authors.initials: S
authors.lastname: Fanello
mesh_terms: D015709:Correspondence as Topic; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D012017:Referral and Consultation; D014218:Triage