Relieving the pediatric emergency department by referring low triaged patients using the Manchester Triage System

In 2015, the pediatric emergency department (PED) of the Department of Pediatrics and Adolescent Medicine, Vienna General Hospital, reached its capacity with 25,000 patient visits, leading to delays in assessment and overcrowding. Self-referred patients constituted 95%, with 75% classified as low urgency level 4 (UL-4; green) and 5 (UL-5; blue) according to the Manchester Triage System (MTS). In 2016, a referral process was established in collaboration with local pediatric offices and the pediatric departments of the Vienna Hospital Association to refer low-triaged patients for medical assessment, reducing total visits to 16500 by 2017. This study aimed to evaluate patient safety, satisfaction, and diagnosis of referred patients. Between June 2017 and May 2018, UL-4 and UL-5 referred patients were included (n = 2394). Data on diagnosis, treatment, and satisfaction were collected via a survey from 568 patients (23.7%). Of all referred patients, 6 (1.1%) required hospitalization, with no significant differences in hospitalization rates across age groups (p = 0.861) or gender (p = 0.766). The most common medical issues were respiratory diseases, both in outpatients (n = 198/562, 35.6%) and inpatients (n = 4/6, 66.7%). Families' satisfaction levels with the process at the PED and external treatment were high (n = 530, 93.3% and n = 477, 84.0%, respectively). Dissatisfaction was higher with the PED (n = 26, 4.6% vs. n = 23, 4.0%), linked to unclear referral communication.

The referral of low-urgency patients using the MTS can reduce PED congestion, without compromising patient safety and satisfaction levels.

• The MTS is widely used as a valid and reliable tool in PEDs. • Overcrowding in PEDs is a common issue, leading to the need for alternative management strategies, particularly for nonurgent cases.

• The burden on the overcrowded PED can be effectively alleviated by redirecting low-triaged pediatric patients (UL-4 and UL-5) using the MTS to primary or secondary care medical centers. • The study provides evidence that referred pediatric patients and their families experience satisfaction with provided care and that there is no relevant increase in hospitalization rates or adverse outcomes.