Triaging and Referring in Adjacent General and Emergency Departments

NCT ID: NCT03793972

Last Updated: 2025-03-11

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

8158 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-04

Study Completion Date

2019-12-31

Brief Summary

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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.

Detailed Description

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Conditions

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Triage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster randomised with weekends servings as clusters.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Triage with referral to primary care

Triage and referral according to eMTS.

Group Type EXPERIMENTAL

Triage with referral to primary care

Intervention Type 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 without referral to primary care

Weekends with usual care

Group Type ACTIVE_COMPARATOR

Usual care

Intervention Type 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.

Interventions

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Triage with referral to primary care

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.

Intervention Type OTHER

Usual care

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.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* availability of a Belgian citizen national insurance number

Exclusion Criteria

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

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Hospital, Antwerp

OTHER

Sponsor Role collaborator

Research Foundation Flanders

OTHER

Sponsor Role collaborator

Universiteit Antwerpen

OTHER

Sponsor Role lead

Responsible Party

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Veronique Verhoeven

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Veronique Verhoeven, PhD

Role: PRINCIPAL_INVESTIGATOR

Univeristeit Antwerpen

Locations

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AZ Monica

Deurne, , Belgium

Site Status

HuisartsenWachtpost Antwerpen Oost

Deurne, , Belgium

Site Status

Countries

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Belgium

References

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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.

Reference Type DERIVED
PMID: 35777880 (View on PubMed)

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.

Reference Type DERIVED
PMID: 35395840 (View on PubMed)

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.

Reference Type DERIVED
PMID: 34731198 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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T000718N

Identifier Type: -

Identifier Source: org_study_id

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