Triaging and Referring in Adjacent General and Emergency Departments

NCT03793972 | Completed Results

• 1 other identifier: T000718N
• Study Type: interventional
• Target: 8,158
• Locations: 1 country
• Sites: 2

Brief Summary

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: The investigators will conduct a cluster randomised controlled trial in which eligible ED patients will be diverged to the GPC using the eMTS. The investigators will collect data using the iCAREdata database. The investigators 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 not following the triage advice and file review for selected patients.

Conditions

Triage

Keywords

Triage; Primary Health Care; Emergency Service, Hospital

Outcome Measures

Primary Outcomes (1)

• The Proportion of Patients Presenting at the ED But Being Treated by the GPC After Referral

  The difference between intervention and control period will be calculated. Treatment at the GPC means having a record at the GPC.

  Patient flow will be followed for 24 hours after presentation at the ED

Study Arms (2)

Triage with referral to primary care

EXPERIMENTAL

Triage and referral according to eMTS.

Other: Triage with referral to primary care

Triage without referral to primary care

ACTIVE COMPARATOR

Weekends with usual care

Other: Usual care

Interventions

Triage with referral to primary care OTHER

During intervention weekends(and holidays) a nurse will triage patients using a newly developped extended Manchester Triage System (eMTS). Patients appropriate for primary care will be referred to the general practitioner on call.We will inform patients about the nature of the intervention using leaflets and broadcasting in the waiting room of the Emergency Department.

Triage with referral to primary care

Usual care OTHER

During a control weekend (and holidays), all data registration and collection will be the same as during intervention weekends but patents will not be informed about their allocation advice. The emergency physician will see all patients deciding to stay at the ED, without influence of the triage advice. As in standard clinical care, patients will have the right to change their mind and go spontaneously to the general practitioner. . During control weekends, we will only inform about triage in general but no about the general practioner or the intervention.

Triage without referral to primary care

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• availability of a Belgian citizen national insurance number

You may not qualify if:

• Patients arriving at the ED by an ambulance with a doctor or nurse
• Patients all ready admitted to an other hospital department

Sponsors & Collaborators

• Universiteit Antwerpen: lead
• University Hospital, Antwerp: collaborator
• Research Foundation Flanders: collaborator

Study Sites (2)

AZ Monica

Deurne, 2100, Belgium

Location

HuisartsenWachtpost Antwerpen Oost

Deurne, 2100, Belgium

Location

Related Publications (3)

• Morreel S, Verhoeven V, Philips H, Meysman J, Homburg I, De Graeve D, Monsieurs KG. Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial. BMJ Open. 2022 Jul 1;12(7):e059173. doi: 10.1136/bmjopen-2021-059173.

  PMID: 35777880 DERIVED

• Homburg I, Morreel S, Verhoeven V, Monsieurs KG, Meysman J, Philips H, De Graeve D. Non-compliance with a nurse's advice to visit the primary care provider: an exploratory secondary analysis of the TRIAGE-trial. BMC Health Serv Res. 2022 Apr 8;22(1):463. doi: 10.1186/s12913-022-07904-8.

  PMID: 35395840 DERIVED

• Morreel S, Philips H, De Graeve D, Monsieurs KG, Kampen JK, Meysman J, Lefevre E, Verhoeven V. Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial. PLoS One. 2021 Nov 3;16(11):e0258561. doi: 10.1371/journal.pone.0258561. eCollection 2021.

  PMID: 34731198 DERIVED

MeSH Terms

Conditions

Emergencies

Interventions

Triage

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Emergency Medical Services; Health Services; Health Care Facilities Workforce and Services

Results Point of Contact

• Title: Stefan Morreel
• Organization: UAntwerpen

stefan.morreel@uantwerpen.be

003232658721

Study Officials

• Veronique Verhoeven, PhD

  Univeristeit Antwerpen

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Model Details: Cluster randomised with weekends servings as clusters.

Study Record Dates

• First Submitted: January 2, 2019
• First Posted: January 4, 2019
• Study Start: January 4, 2019
• Primary Completion: December 31, 2019
• Study Completion: December 31, 2019
• Last Updated: March 11, 2025
• Results First Posted: March 11, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will not share

Locations

BE (2)