Telephone triage and initial clinical assessment in emergency medicine to manage patient flow: One size fits all?

Abstract

Overcrowded emergency rooms have been the subject of public interest in recent years. The reasons for this are seen in the increased expectations of patients, the use of 24/7 available diagnostic options, the lack of timely care by specialists and the aging of general practitioners in the absence of junior staff in this sector. Politicians and professional associations therefore demand better control of patient flows in the sectors responsible for outpatient and inpatient emergency care. The proposals now available envision providing either the patient help by telephone or video counseling by a physician or directly assigning the person an appointment. On the other hand, patients should be assigned to the competent outpatient or inpatient sector by telephone triage or at the common counter of an emergency center/emergency practice. The initial assessment system required for this is currently being developed and evaluated on the basis of the Swiss telephone triage model for German conditions. From the point of view of clinical emergency medicine, this initial assessment system has been developed and evaluated for the low-risk practice area and not for the high-risk emergency center area. Due to medical and legal concerns, the system in its current form at a common counter is therefore rejected by emergency medical services. On the contrary, the emergency centers consider qualified triage to be practicable and legally binding on the basis of a physician-delegated nursing-assisted initial assessment using validated initial assessment systems (e.g. Manchester Triage System or Emergency Severity Index).