Roger Daglius Dias1, Izabel Cristina Rios2, Carlos Luis Benites Canhada3, Maria Dolores Galinanes Otero Fernandes3, Leila Suemi Harima Letaif3, Eloisa Bonfá4, Maria Beatriz Moliterno Perondi5. 1. 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). 2. 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. 3. Emergency Department, Instituto Central do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 4. Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 5. 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.
Abstract
OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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: João Carlos Pereira Gomes; Roger Daglius Dias; Jacson Venancio de Barros; Irineu Tadeu Velasco; Wilson Jacob Filho Journal: BMC Emerg Med Date: 2020-06-11
Authors: Stefan Morreel; Hilde Philips; Diana De Graeve; Koenraad G Monsieurs; Jarl K Kampen; Jasmine Meysman; Eva Lefevre; Veronique Verhoeven Journal: PLoS One Date: 2021-11-03 Impact factor: 3.240