Triaging and Referring In Adjacent General and Emergency departements (the TRIAGE-trial): a cluster randomised controlled trial.

Introduction: Patients who might also go to the general practitioner (GP) frequently consult emergency departments (ED). This leads to additional costs for both government and patient and a high workload for emergency physicians in Flanders. The Belgian government wants to address this problem by improved collaboration between EDs and general practice cooperatives (GPCs). Intervention: Patients presenting at the ED during out-of-hours (OOH) will be triaged and allocated to the most appropriate service. For this purpose the Manchester Triage System (MTS) which is commonly used in Flemish hospitals, will be extended (eMTS). By doing so a trained nurse will be able to diverge suitable patients towards the GPC. Methodology: We will conduct a cluster RCT in which eligible ED patients will be diverged to the GPC using the eMTS. We will collect data using our operational anonymous database for OOH care (iCAREdata). We will study the use of the eMTS, the effectiveness and effects of triage, work load changes, epidemiology at both departments, patient safety, health insurance (HIS) and patient expenditures. Furthermore facilitators and barriers will be studied and an incident analysis of problem cases will be performed. Outcome: The primary outcome is the proportion of patients who enter the ED and are handled by the GP after triage. Secondary outcome measurements are related to safety: referral rate to the ED by the GP, proportion of patients visiting the ED again within two weeks, proportion of patients not following the triage advice and file review for selected patients. Results: We will generate a generic model of triage applicable to all Belgian EDs and GPCs. The model will consist of a validated triage instrument, a manual for setting up triage and scientific support for both effectiveness and safety. In addition we expect to achieve financial savings for the HIS and for the patient.

Keywords:EMERGENCY CARE, HEALTH CARE COST, WEEKEND, HEALTH CARE DECISION MAKING

Disciplines:Public health care, Public health sciences, Public health services, Applied economics, Emergency medicine

Project type:Collaboration project