Advanced triage to redirect non-urgent emergency department visits to alternative care centers: the PERSEE algorithm

[en] Objectives: Primary care treatable visits in the Emergency Department (ED) are part of the different factors leading to the overcrowding. Their triage and diversion to alternative care centers could potentially help manage the increasing inflow provided the establishment of an advanced triage to ensure patients’ safety. We aim to suggest a new triage tool, PERSEE, and prove its feasibility, safety and performance. Methods: All self-referrals presented to the ED were triaged with the PERSEE algorithm: first, patients were classified with a five-level ED acuity scale and then evaluated by algorithms to determine their appropriate category (ED or Primary Care). Patients were eligible for a redirection if they were triaged by the acuity scale as level 3 or lower, considered as ambulatory patients and finally categorized as primary care patients. We defined appropriate redirections as patients requiring less than three emergency resources, no emergency-specific treatment and no hospitalization. Results: During the study, 1999 patients were admitted to the ED. Among those, 1333 patients were self-referred (66.9%) of whom 1167 patients were triaged as level 3 or below (58.6%) and 775 patients triaged as ambulatory (39.0%). Among the 775 patients, 200 patients were categorized as primary care treatable (10.0%) and thereby, as potentially eligible for a redirection. We noticed an error rate of 7%, sensitivity of 24.06% and specificity of 97.6%. The redirection rate reached 15% of the self-referrals. Conclusion: These results indicate that PERSEE triage could lead to a safe redirection and could be an efficient tool to reduce ED crowding provided several adjustments.

Disciplines :

Public health, health care sciences & services

Author, co-author :

GILBERT, Allison ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des urgences

BRASSEUR, Edmond ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des urgences

PETIT, Meredith ; Centre Hospitalier Universitaire de Liège - CHU > Département infirmier > Urgences Sart-Tilman

Donneau, Anne-Françoise ; Université de Liège - ULiège > Département des sciences de la santé publique > Biostatistique

D'Orio, Vincenzo ; Université de Liège - ULiège > Département des sciences cliniques > Médecine d'urgence - bioch. et phys. hum. normales et path.

GHUYSEN, Alexandre ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des urgences

Language :

English

Title :

Advanced triage to redirect non-urgent emergency department visits to alternative care centers: the PERSEE algorithm

Publication date :

15 April 2021

Journal title :

Acta Clinica Belgica

ISSN :

1784-3286

eISSN :

2295-3337

Publisher :

Taylor and Francis, Abingdon, United Kingdom

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 22 April 2021

Statistics

Number of views

145 (28 by ULiège)

Number of downloads

14 (11 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Van Den Heede K, Van De Voorde C. Interventions to reduce emergency department utilization: a review of reviews. Health Policy. 2016; 120(12): 1337–1349.
Jarvis PRE. Improving emergency department patient flow. Clin Exp Emerg Med. 2016; 3 (2): 63–68.
Derlet RW, Richards JR. Overcrowding in the Nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000; 35 (1): 63–68.
Filippatos G, Evridiki K. The effect of emergency department crowding on patient outcomes. Health Sci J. 2015; 9 (1): 1 –6.
Pitts SR, Niska W, Burt CW, et al. National hospital ambulatory medical care survey: 2006 emergency department summary. Natl Health Stat Rep. 200 8; 7: 1 –38.
Berchet C. Emergency care services: trends, drivers and interventions to manage demand. OECD Health Working Pap. 2015; 83: 1–49.
Van Den Heede K, Dubois C, Devriese S, et al. Organisation and payment of emergency care services in Belgium: current situation and options for reform. Health Services Research. Brussels: Belgian Health Care Knowledge Centre (KCE); 2016. (KCE Report 263Bs). Available from: https://kce.fgov.be/sites/default/files/atoms/files/KCE_263_Organisation_and_payment_of_emergency_care_services_0.pdf
Thompson MIW, Lasserson D, McCann L, et al. Suitability of emergency department attenders to be assessed in primary care survey of general practitioner agreement in a random sample of triage records analyzed in a service evaluation project. BMJ Open. 2013; 3: e003612.
Elley CR, Randall PJ, Bratt D, et al. Can primary care patients be identified within an emergency department workload? N Z Med J. 2007; 120 (1256): 1–12.
Sempere-Selva T, Peiro S, Sendra-Pina P, et al. Inappropriate use of an accident and emergency department: magnitude, associated factors and reasons– a, approach with explicit criteria. Ann Emerg Med. 2001; 37 (6): 568–579.
Van Den Heede K, Quentin W, Dubois C, et al. The 2016 proposal for the reorganisation of urgent care provision in Belgium: a political struggle to co-locate primary care providers and emergency departments. Health Policy. 2017; 121: 339–345.
Crawford J, Cooper S, Cant R, et al. The impact of walk-in centers and GP co-operatives on emergency department presentations: a systematic review of the literature. Int Emerg Nurs. 2017; 34: 36–42.
Behcet C, Nader C. The organization of out-of-hours primary care in OECD countries. OECD Working Pap. 2016; 89: 1–45.
Dale J, Green J, Reid F, et al. Primary care in the accident and emergency department: prospective identification of patients. BMJ. 1995; 311: 423–426.
Chmiel C, Wang M, Sidler P, et al. Implementation of a hospital-integrated general practice– a successful way to reduce the burden of inappropriate emergency-department use. Swiss Med Wkly. 2016; 146: 1–9.
Washington DL, Stevens CD, Shekelle PG, et al. Next-Day care for emergency department users with non-acute conditions: a randomized controlled trial. Ann Intern Med. 2002; 137: 707–715.
O’Kelly FD, Teljeur C, Carter I, et al. Impact of a GP cooperative on lower acuity emergency department attendances. Emerg Med J. 2010; 27: 770–773.
Veelen MJ, Van Den Brand CL, Reijnen R, et al. Effects of a general practitioner cooperative co-located with an emergency department on patient throughput. World J Emerg Med. 2016; 7 (4): 270–273.
Ramlakhan S, Mason S, O’Keeffe C, et al. Primary care services located with EDs: a review of effectiveness. Emerg Med J. 2016;33(7):495–503.
Colliers A, Remmen R, Streffer ML, et al. Implementation of a general practitioner cooperative adjacent to the emergency department of a hospital increases the caseload for the GPC but not the emergency department. Acta Clin Belg. 2016; 72 (1): 49–54.
Derlet RW, Kinser D, Ray L, et al. Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study. Ann Emerg Med. 1995; 25 (2): 215–223.
Washington DL, Stevens CD, Shekelle PG, et al. Safely directing patients to appropriate levels of care: guideline-driven triage in the emergency service. Ann Emerg Med. 2000; 36 (1): 15–22.
Jobe J, Ghuysen A, Gerard P, et al. Reliability and validity of a new French-language triage algorithm: the ELISA scale. Emerg Med J. 2014; 31 (2): 115–120.
Brasseur E, Servotte JC, Donneau AF, et al. Triage for out-of-hours primary care calls: a reliability study of a new fren-language algorithm, the SALOMON rule. Scand J Prim Health Care. 2019;37(2):227–232.
Kirkland SW, Soleiman A, Rowe BH, et al. A systematic review examining the impact of redirecting low-acuity patients seeking emergency department care: is the juice worth the squeeze? Emerg Med J. 201 9;36(2):97–106.
Vertesi L. Does the Canadian Emergency Department Triage and Acuity Scale identify non-urgent patients who can be triaged away from the emergency department? CJEM. 2004; 6 (5): 337–342.
Van Gils-Van Rooij ESJ, Joris Yzermans C, Broekmans SM, et al. Out-of-hours care collaboration between general practitioners and hospital emergency departments in the Netherlands. J Am Board Fam Med. 2015; 28 (6): 807–815.
Rutten M, Vrielink F, Smits M, et al. Patient and care characteristics of self-referrals treated by the general practitioner cooperative at emergency-care-access-points in the Netherlands. BMC Fam Pract. 2017; 18 (62): 1–7.
Thijssen WAMH, Wijnen-van Houts M, Koetsenruijter J, et al. The impact on emergency department utilization and patient flows after integrating with a general practitioner cooperative: an observational study. Emerg Med Int. 2013; 2013:364659.
Gilbert A, Brasseur E, Ghuysen A, et al. Nouvelle Approche de régulation de la demande de soins non planifiés: L’application interactive d’auto-triage ODISSEE. Rev Med Liège. 2020; 75 (3): 159–163.
Moreel S, Colliers A, Remmen R, et al. How accurate is telephone triage in out-of-hours care? An observational trial in real patients. Acta Clin Belg. 2020: 1–6. Online ahead of print. DOI: 10.1080/17843286.2020.1839719
Wang M, Wild S, Hilfiker G, et al. Hospital-integrated general practice: a promising way to manage walk-in patients in emergency departments. J Eval Clin Pract. 2014; 20: 20–26.
Begum F, Khan H, Moss D. Evaluation of GP-lead service to identify and redirect patients from A&E to primary care services. Cited 2021 Feb 25. Available from: https://www.healthylondon.org/wp-content/uploads/2017/10/30.-Solving-the-AE-crisis-using-GP-lead-triage-and-redirection.pdf
Hess S, Sidler P, Chmiel C, et al. Satisfaction of health professionals after implementation of a primary care hospital emergency center in Switzerland: a prospective before-after study. Int Emerg Nurs. 2015; 23: 286–293.