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Using the Manchester triage system for refusing nonurgent patients in the emergency department: A 30-day outcome study

Roger Daglius Dias, MD, MBA, PhD, Izabel Cristina Rios, MD, PhD, Carlos Luis Benites Canhada, MSc, Maria Dolores Galinanes Otero Fernandes, BSW, Leila Suemi Harima Letaif, MD, MBA, Eloisa Bonfá, MD, PhD, Maria Beatriz Moliterno Perondi, MD, MBA


Objective: To evaluate the long-term outcomes and satisfaction of nonurgent patients who seek care in the emergency department (ED) and are diverted to primary health services (PHS).

Methods: Data were collected from 264 nonurgent patients diverted from the ED of a tertiary public university hospital in São Paulo, Brazil. The nonurgent patient definition was performed by Manchester triage system version II (MTS-II) associated to medical interview in the triage service. Satisfaction levels were evaluated by telephone interviews. The outcomes were assessed within 30 days after the ED visit.
Results: Based on the MTS-II, 56.4 percent of the diverted patients were classified as green, 34.3 percent as blue, and 9.3 percent as white. Only one patient required a hospital admission and no deaths were registered within 30 days after ED diversion. After diversion, the majority of patients searched for PHS (62.7 percent), 14.4 percent sought out other EDs, and 22.9 percent did not seek out any other health services. Regarding patient satisfaction, 61.9 percent evaluated the triage team as fair, good, or very good.

Conclusions: Our study suggests that diverting nonurgent patients from the ED to PHS may be carried out in a hierarchic system like the Brazilian public healthcare system. The MTS-II can be a useful triage system to support physician in the diverting process. In addition, patient satisfaction with the refusing was reasonable. Future studies should be designed to evaluate patient safety outcomes in a larger sample and in different healthcare systems.


nonurgent patients, emergency department overcrowding, triage system

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