Safety and efficacy of hospital emergency department discharge from triage by nurses accredited to use an algorithmic aid for the Spanish Triage System without physician evaluation

Objective: To assess the safety and efficacy of discharge from a hospital emergency

department with referral to another point of care based on the application of an

algorithmic aid to triage (AAT) by nurses without physician evaluation of the patient.

Methods: Analysis of results for the first year’s application of the AAT in the emergency

department of the Villaroell center of Hospital Clínic de Barcelona (CVill). The AAT was

used to assess all patients entering triage and in the visits referred to the hospital’s

emergency clinic on Carrer Valencia (CVal).

Results: Of 102 063 visits to CVill, 64 425 occurred when the CVal was operating. Of the

3589 patients (3.5%) referred to the CVal, 3384 (94.3%) actually went to the referral

clinic. A level V triage classification, residence outside the city of Barcelona, and visits

made during holiday periods were independent predictors of a patient’s failure to go to

the CVal clinic. Of the 3384 patients who went to the CVa, 3270 (96.6%) were

discharged and 114 (3.4%) were transferred to other centers. A history of prior visits to

the CVill, advanced age, visiting on a working day, and level V triage classification were

independent predictors of transfer to another center from the CVal. Only 11 of the

transferred patients (10%) required hospital admission (0.3% of the initial visits

discharged by the nurses with referral). No independent variables predicted hospital

admission and no patient died.

Conclusions: Referral without physician evaluation by nurses accredited to use the AAT is

safe and effective. Variables that predicted failure to go to the referral center may be

useful for further development of the AAT as a tool for deciding where to send a patient

for emergency care.