Advanced triage to redirect non-urgent Emergency Department visits to alternative care centers: the PERSEE algorithm

Gilbert, Allison; Brasseur, Edmond; Petit, Meredith; Donneau, Anne Françoise; D’Orio, Vincent; Ghuysen, Alexandre

doi:10.1080/17843286.2021.1914948

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…However, these algorithms have shown their efficiency through this 5-year experience but also on a daily basis during 10 years of real-life clinical practice. Different new studies are now in progress to develop new triage systems based on the SALOMON algorithms, such as a patient's self-triage platform or a ED diversion triage to alternative care centers for non-emergency visits [22,23].…”

Section: Discussionmentioning

confidence: 99%

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

Brasseur¹,

Gilbert²,

Donneau

et al. 2021

Acta Clinica Belgica

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Objectives:Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. Methods:In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. Results:10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. Conclusion:SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.

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Section: Discussionmentioning

confidence: 99%

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

Brasseur¹,

Gilbert²,

Donneau

et al. 2021

Acta Clinica Belgica

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“…The VR scenario was based on a major train crash with multiple victims, designed and validated by a team of experts (nurses, emergency physicians) [6,23,24] to train the participant apply START triage and first aid techniques (tourniquet placement, bleeding management, etc.) in specific situations.…”

Section: Study Setting and Designmentioning

confidence: 99%

Collaborative virtual reality environment in disaster medicine: moving from single player to multiple learners

Abensur Vuillaume,

Goffoy,

Dubois

et al. 2024

BMC Med Educ

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Background The use of virtual reality (VR) in healthcare education is on the increase. In disaster medicine, it could be a solution to the cost and logistic constraints for a “full-scale” scenarios. However, VR is mainly designed for single players, which is not appropriate for the objectives pursued in disaster medicine. We decided to evaluate the educational value of using individual VR simulation in disaster medicine on a group of learners. Methods The VR scenario used was a reproduction of a major train crash, with 21 victims and whose objectives were START triage and first aid techniques. The sessions were carried out in multi-participant groups with different roles (active and immersed with headset, paper triage without headset, and active for communications not immersed in the headset). Their perceived self-efficacy was assessed before (T0), after (T1) and 2 months (T2) after the training. Satisfaction and confidence in learning were also measured. Results The median levels of satisfaction and confidence in learning were of 21/25 and 32/40 respectively. Their perceived self-efficacy increased significantly between T0 and T1 (p < 0.001), and remained stable until T2. The different roles of participant showed no difference in terms of satisfaction, confidence in learning or changes in perceived self-efficacy. One third of the participants agreed that the number of participants had interfered with their learning. A significant negative correlation (rS = -0.51, p = 0.002) was found between satisfaction and the fact of having been hindered by the number of participants. Around 90% of participants found the activity entertaining and found the new technologies appropriate for learning technical skills. Conclusions This first experience of VR in a group setting is satisfactory and shows its positive effects. The limitations highlighted here will enable areas of improvement to be identified for the use of VR in disaster medicine, pending the development of multi-player tools. It would now be appropriate to analyse the impact of this type of simulation on learning and its retention over time.

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“…Kritisch wird diskutiert, welches Verfahren eine sichere Ersteinschätzung als Grundlage der Weiterleitung bietet, da die zur zeitlichen Priorisierung in Notaufnahmen eingesetzten Verfahren, beispielsweise das Manchester Triage System (MTS), dafür allein nicht ausreichend sein dürften [ 15 ]. Denkbar wäre eine Kombination mit einem Telefontriageverfahren [ 16 , 17 ]. Tatsächlich findet sich in der Literatur bislang kein etabliertes Verfahren zur Unterstützung von Steuerungsentscheidungen hinsichtlich der Weiterleitung von einer Notaufnahme in eine räumlich entfernte Einrichtung zur ambulanten Versorgung.…”

Section: Diskussionunclassified

Notfallversorgung – Reformbedarf aus ambulanter Sicht

Stillfried

Mangiapane

2022

Innere Medizin

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ZusammenfassungSeit Jahren stehen Reformen der Akut- und Notfallversorgung auf der gesundheitspolitischen Agenda. So auch im aktuellen Koalitionsvertrag. Zur Einordnung der Ausgangslage werden ein inhaltlicher Rückblick sowie eine Analyse der Abrechnungsdaten aus der ambulanten und stationären Notfallversorgung vorgenommen. Folgt man der Hypothese, dass bisherige Reformansätze insbesondere auf einen Anstieg ambulant vertragsärztlich behandelbarer Fälle in der Notfallversorgung reagierten, muss die Fallzahlentwicklung in der Dekade bis zum Pandemiebeginn (2010–2019) zur Kenntnis genommen werden. Sie zeigt eine Stagnation der Fallzahl in Notaufnahmen und einen seit 2016 rückläufigen Trend insbesondere bei ambulanten Notfallbehandlungen durch Krankenhäuser. Dieser Effekt kann nicht zweifelsfrei auf bereits eingeführte Maßnahmen zur Patientensteuerung (Bereitschaftspraxen, Telefontriage) zurückgeführt werden. Die Analyse der Abrechnungsdiagnosen spricht dafür, dass eine klare Arbeitsteilung zwischen Bereitschaftspraxen und Notaufnahmen besteht. Die konsistente Verlagerung der Fälle hochbetagter Patienten in die ambulante Versorgung durch Notaufnahmen legt aber eine notwendige Weiterentwicklung dieser Arbeitsteilung nahe. Weitere Maßnahmen der Steuerung durch Weiterleitung von Patienten aus Notaufnahmen in die vertragsärztliche Versorgung müssen noch im Detail beschlossen und umgesetzt werden (§ 120 Abs. 3b Sozialgesetzbuch [SGB] V). In der Diskussion wird die Auffassung vertreten, dass Implementierung und Evaluation dieser Maßnahmen abgewartet werden sollten, bevor weitergehende Reformschritte ergriffen werden.

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Advanced triage to redirect non-urgent Emergency Department visits to alternative care centers: the PERSEE algorithm

Cited by 8 publications

References 23 publications

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

Collaborative virtual reality environment in disaster medicine: moving from single player to multiple learners

Notfallversorgung – Reformbedarf aus ambulanter Sicht

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