Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: A prospective cohort study

Abstract

Objectives To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany. Design Prospective cohort study. Setting Single centre University Hospital Emergency Department. Participants Adult, non-surgical ED patients. Exposure A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS. Primary and secondary outcome measures Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality). Results A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420). Conclusions The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care. Trial registration number U1111-1119-7564; Post-results.