title: Using the Manchester triage system for refusing nonurgent patients in the emergency department: A 30-day outcome study.
abstract: To evaluate the long-term outcomes and satisfaction of nonurgent patients who seek care in the emergency department (ED) and are diverted to primary health services (PHS).
  
  
  
  Data were collected from 264 nonurgent patients diverted from the ED of a tertiary public university hospital in São Paulo, Brazil. The nonurgent patient definition was performed by Manchester triage system version II (MTS-II) associated to medical interview in the triage service. Satisfaction levels were evaluated by telephone interviews. The outcomes were assessed within 30 days after the ED visit.
  
  
  
  Based on the MTS-II, 56.4 percent of the diverted patients were classified as green, 34.3 percent as blue, and 9.3 percent as white. Only one patient required a hospital admission and no deaths were registered within 30 days after ED diversion. After diversion, the majority of patients searched for PHS (62.7 percent), 14.4 percent sought out other EDs, and 22.9 percent did not seek out any other health services. Regarding patient satisfaction, 61.9 percent evaluated the triage team as fair, good, or very good.
  
  
  
  Our study suggests that diverting nonurgent patients from the ED to PHS may be carried out in a hierarchic system like the Brazilian public healthcare system. The MTS-II can be a useful triage system to support physician in the diverting process. In addition, patient satisfaction with the refusing was reasonable. Future studies should be designed to evaluate patient safety outcomes in a larger sample and in different healthcare systems.
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; STRATUS Center for Medical Simulation, Harvard Medical School, Brigham and Women's Hospital, Massachusetts, Boston (current affiliation).
authors.forename: Roger Daglius
authors.initials: RD
authors.lastname: Dias
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Izabel Cristina
authors.initials: IC
authors.lastname: Rios
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Carlos Luis Benites
authors.initials: CL
authors.lastname: Canhada
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Maria Dolores Galinanes Otero
authors.initials: MD
authors.lastname: Fernandes
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Leila Suemi Harima
authors.initials: LS
authors.lastname: Letaif
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Eloisa
authors.initials: E
authors.lastname: Bonfá
authors.affiliation: Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Emergency Department, Instituto da Criança do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Maria Beatriz Moliterno
authors.initials: MB
authors.lastname: Perondi
mesh_terms: D001938:Brazil; D015331:Cohort Studies; D003441:Crowding; D004636:Emergency Service, Hospital; D006297:Health Services Accessibility; D006760:Hospitalization; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D000069342:Medical Overuse / Q000517:prevention & control*; D017060:Patient Satisfaction; D011320:Primary Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation; D016079:Refusal to Treat; D018570:Risk Assessment; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014218:Triage / Q000379:methods*