Triage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been
implemented empirically but no triage algorithm has been validated to date. A triage algorithm
named SALOMON (Syst eme Algorithmique Li egeois d’Orientation pour la M edecine
Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance
of the algorithm using simulated PCP calls.
Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination
of SALOMON’s inter-rater agreement by comparing the actual choices of a specific triage
flowchart and the level of care selected as compared with reference assignments. Intra-rater
agreement was estimated by comparing triage after training (T1) and 3 to 6 months after
SALOMON use in clinical practice (T2).
Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at
T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart
and triage level accuracy improved significantly from T1 to T2 (p<0.0001). SALOMON algorithm
use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively.
Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP
calls triage by nurses. The criterion validity of this algorithm should be further evaluated
through its implementation in a real life setting.