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Impact of the ABCDE triage on the number of patient visits to the emergency department

Jarmo Kantonen12, Johanna Kaartinen3, Juho Mattila4, Ricardo Menezes5, Mia Malmila1, Maaret Castren6 and Timo Kauppila1789*

Author Affiliations

1 City of Vantaa, Finland

2 Attendo-Medone LTD, Finland

3 Peijas Hospital, Helsinki University Central, Hospital, Finland

4 Helsinki University Central Hospital, Helskinki, Finland

5 Emergency unit project, Jorvi Hospital, Puolarmetsä Hospital (City of Espoo), Finland

6 Karolinska Institutet, Department of clinical Sciences and Education, Södersjukhuset, Stockholm, Sweden

7 Network of Academic Health Centres, Departments of General Practice and National Public Health, University of Helsinki, Finland

8 Department of Primary Healthcare, Institute of Clinical Medicine, and Department of National Public Health, University of Helsinki, Finland

9 Department of National Public Health, University of Helsinki, Finland

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BMC Emergency Medicine 2010, 10:12  doi:10.1186/1471-227X-10-12

Published: 3 June 2010



Many Finnish emergency departments (ED) serve both primary and secondary health care patients and are therefore referred to as combined emergency departments. Primary care specialists are responsible for the initial assessment and treatment. They, thereby, also regulate referral and access to tertiary care. Primary health care EDs are easy for the public to access, leading to non-acute patient visits to the emergency department. This has caused increased queues and unnecessary difficulties in providing immediate treatment for those patients who need it the most.


A face-to-face triage system based on the letters A (patient directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital) as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse). If the patient was not considered to be in need of immediate care (i.e. A-D) he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrmäki in Vantaa, Jorvi and Puolarmetsä in Espoo). To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public office hour services of Vantaa primary care.


The number of patient visits to a primary care doctor in 2004 decreased by up to eight percent (340 visits/month) as compared to the previous year in the Peijas ED after implementation of the ABCDE-triage system. Simultaneously, doctor visits in tertiary health care ED increased by ten percent (125 visits/month). ABCDE-triage was not associated with a subsequent increase in the number of patient visits in the private health care or office hour services. The number of ED visits in the City of Espoo, used as a control where no triage was applied, remained unchanged.


The present ABCDE-triage system combined with public guidance may reduce patient visits to primary health care EDs but not to the tertiary health care EDs.