Triaging Patients Away From the Emergency Department: A Review of the Issues

Abstract

Overcrowding is a serious issue confronting Emergency Departments (EDs). With the intention of decreasing ED demand, there has been a focus on determining those patients who do not require the services of the ED so they can be redirected away to an alternative health care provider or facility. Co-locating an after-hours primary health care facility near to the ED is a model under consideration in some District Health Boards. This model suggests that a substantial proportion of the patients currently managed in the ED can be assessed and managed in a general practice setting. It is envisaged that by redirecting the lower acuity patients away from the ED, overcrowded EDs will be relieved. This is despite evidence demonstrating that low acuity patients are not the cause of ED overcrowding. Moreover, being treated at the ED is the only safety net for many people in the community who cannot afford alternative care.

This research report discusses the literature regarding the practice of referring or redirecting patients away from the ED and the issues associated with this model. In doing this, it looks at the Australasian Triage Scale, the system used to ensure patients in the ED are seen in order of clinical urgency, because it has been suggested that this system could be used as a tool to refer patients away from the ED. Even though some people presenting to ED could be seen by another health care provider, the triage system is not an appropriate tool for achieving this. While it is tempting to believe that patients in the lower triage categories are prime candidates for being referred away, there is evidence from hospital statistics that patients in these categories have a high number of hospital admissions and in-hospital death rates. Additionally, to complicate matters, there is no universal definition of what constitutes an 'appropriate' ED presentation and no consensus of opinion amongst health professionals in deciding patients' 'appropriateness'. For these reasons it is unethical to expect nurses who administer the triage system to use it for the purpose of referring people away from the ED.