The physician is necessary in triage at Tertiary Hospital Emergency Department

Aim: To assess the need of a physician on the ED triage, with the aim of identifying high-complexity patients using Manchester Triage System (MTS) at an Emergency Department. Methods: Prospective observational study which enrolled all patients classified as very urgent (level 2 or orange) and urgent (level 3 or yellow) by the MTS in the First Assistance Unit (FAU) of the Emergency Department during a period of 12 hours, to be assessed by an experimented physician who decided the immediate location in an acute care or FAD area based on medical criteria. The validity of the decision was established according to the destiny of the patients once visited and measured by the admission index. Results: The study included 100 patients, 45 of whom were eligible for the study, 10 (22.22%) placed by the MTS in acute care area as very urgent or orange and 35 (77.78%) in FAU area as urgent or yellow. The admission index of patients placed in acute care area by MTS was 40% (N=4) and in those placed in FAU area was 20% (N=7) (p=0.23). The triage physician placed 12 patients (26.67%) in an acute care area, 4 (8.89%) due to technical procedures and 8 (17.78%) due to their complexity and 33 patients (73.33%) in a FAD area. According to the physician criteria, the admission index of the patients placed in an acute care area due to their complexity was 87.5% (N=7) and of those placed in FAU 12.1% (N=4) (p<0,000). Conclusions: The low capacity of the MTS to detect patients with potential high-complexity, makes the assessment of the physician necessary to guarantee the immediate location, adapting available services to individual necessities and therefore, optimising the resources. [Emergencias 2008; 20: 41-47]