University Hospital Emergency Department: Nurse Versus Primary Care Physician Triage
DOI: 10.3238/zfa.2019.0252-0258german translation / full article
Background: In 2012 an integrated primary care service was started at the central emergency department (ED) of the University Medical Center Hamburg-Eppendorf (UKE). The allocation of patients to different medical and surgical specialties is carried out by experienced nurse practitioners (so-called gatekeepers) at the central reception counter of the ED. It was already shown that such a nurse triage system could benefit from an addition of senior doctors as a measure to reduce ED crowding. This study wanted to find out to which different medical specialties patients were allocated by nurse practitioners (NPs) and whether there was a difference between the decisions by NPs and a family physician (FP). Methods: A cross-sectional study was carried out on three weekdays in July 2018 from 10 a.m. to 6 p.m. Anonymized procedural data were collected from all patients that were registered at the ED. The actual allocation performed by six NPs was compared with a hypothetical allocation of a family physician by means of descriptive statistics and interrater reliability.Results: A total of 246 patients were observed of whom 72.4 % came on foot and 50.4 % came as self-referrals without any prior physician contact. A total of 78.9 % was triaged in the waiting room. Most frequent assignments of ambulatory patients were internal medicine (24.7 %), trauma surgery (19.1 %) and primary care (13.5 %). According to the hypothetic allocation of the observing FP the percentage of primary care patients was 43.3 % of all ambulatory patients. According to this hypothetic reassignment FPs could disburden all medical specialties in the ED.Conclusions: There is a substantial utilization of the ED at UKE by ambulatory patients and self-referrals. The primary care service located at the emergency room of the UKE could initially treat the highest percentage of ambulatory patients of all specialties. This potential is not fully utilized.