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104 Urgences KCE reports vol. 19B
AUTHOR, YEAR
COUNTRY
LEE A. ET AL, 2003
HONG KONG
LEIBOWITZ R ET AL.
2003
AUSTRALIA
LEUNG GM ET AL, 2001
HONG KONG
MARTIN BC, 2000
USA
STUDY DESIGN
Cross-sectional
Validation
SAMPLE
SETTING
1 year
randomly selected patients of A&E
review Original studies and systematic review since
1976
Cross-sectional
Conjoint analysis
390 semi-urgent or non-urgent patients
3 Eds
Cross-sectional Data from clinical records, financial comparative
analyses (3 non-emergent diagnosis)
RESULT / CONCLUSION
The most accurate unweighted nurses' triage classification had an average sensitivity of 87.8%,
specificity of 83.9%, and a PPV of 70.1%. When weighted, the average sensitivity reduced to 75%,
specificity to 65.7%, and PPV to 54%. The most accurate unweighted patients' self-triage
classification yielded a sensitivity of 62.5%, specificity of 69.2%, and a PPV of 58.1%, and
correspondingly reduced to 43.3, 49.2 and 38.6% if weights were applied.
If a mechanism was put in place for additional screening on visitors with a borderline semi-urgent
or non-urgent status, the nurses could safely reassign non-urgent patients to GP care.
The rapid growth in telephone triage and advice services appears to have the advantage of reducing
immediate medical workload through the substitution of telephone consultations for in-person
consultations, and this has the potential to reduce costs. However, this has to be balanced with the
finding of reduced patient satisfaction when in-person consultations are replaced by telephone
consultations.
The relative importance attached to illness severity, waiting time, and consultation fee were 47.8%,
33.6%, and 18.7%, respectively.
Hong Kong patients are receptive to the concept of parallel clinics.
Conjoint analysis is a rigorous survey technique for eliciting the views of patients on health care
services in the ED setting.
Total cost higher in the ED due primarily to differences in ancillary tests and prescription