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 Patients deemed by triage nurses to be “nonurgent” often receive
diagnostic services and procedures, and some are even admitted to
critical care units, researchers found.
Triage was never intended to completely rule out severe illness,
only to give patients an estimate of how long they may have to wait
to see a doctor, the researchers note.
Dr. Renee Y. Hsia of the University of California, San Francisco and
colleagues used a national survey of patient visits to the emergency
department (E.D.) between 2009 and 2011, with triage scores assigned
by a nurse when the patient arrived. The scores range from one to
five, with one through three including immediate, emergency and
urgent patients, and four and five being semi-urgent and nonurgent.
They used data on almost 60,000 observations of patients age 18 to
64 collected between 2009 and 2011, which represented 240 million
E.D. visits. More than 90 percent had a score of one to four and
were deemed “urgent” visits, while about eight percent had a score
of five and were “nonurgent.”
Almost half of nonurgent visits involved diagnostic scans, imaging
or blood tests, and a third involved procedures like splinting or
giving intravenous fluids. For urgent visits, about three-quarters
involved diagnostics and half involved procedures.
About four of every 100 nonurgent visits resulted in hospital
admission, as reported in JAMA Internal Medicine.
Backache, acute upper respiratory infections, soft-tissue
inflammation, and acute sore throat were among the 10 most common
diagnoses for both urgent and nonurgent patients.
“Triage is normally done at the very beginning of the visit, usually
by a triage nurse,” Hsia told Reuters Health by email. “Triaging
patients is an extremely difficult task, since patients are what we
(as providers) call ‘undifferentiated,’ since there has not been
time to do a full history and physical, and nurses have limited
information upon which to base their determination.”
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“We should not expect triage categorization to be perfect, and one
of the goals of this paper is to show that, indeed, triage is not,”
Hsia said.
Many states have policies that patients with Medicaid insurance who
present to the E.D. for “non-urgent” visits will be charged a
co-payment, which may keep people from seeking needed care, even
though the triage system is not perfect, she said.
“It is important that we do not blame the patient for going to the
E.D. if there were no alternatives that were available in a timely
manner,” Hsia said.
“Our study cannot distinguish the reasons behind why we found such a
high proportion of visits that received diagnostic services or
procedures,” she said.
Some of the procedures may not have needed to happen in an E.D.
setting, but since the patients presented there, they were treated,
Hsia added.
SOURCE: http://bit.ly/1WbvBw5 JAMA Internal Medicine, April 18,
2016.
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