Suitability of the Manchester Triage System for the redirection of low-acuity emergency department patients to emergency care by contracted doctors: a holistic cohort study

Background: The establishment of Integrated Emergency Centres (INZ) was proposed for the optimal disposition of self-presenters with low case severity. However, due to the lack of validated instruments for targeted patient routing within INZs, this study investigates whether the Manchester Triage System (MTS) can be used to safely route emergency patients into primary care.Methods: By means of a database query, the MTS categories of all non-traumatological adult emergency patients were determined over a period of 6 weeks. Subsequently, the electronic patient records of all patients with low case severity of MTS categories 4 (green) and 5 (blue) were analysed.Results: Of the 400 consecutive emergency patients in the MTS categories blue (n = 72) and green (n = 328), 139 patients were excluded as primarily not forwardable (presentation with specialist referral [n = 110], admission to bed by ambulance service [n = 29]). Of the remaining 261 patients, 78.1% could have been forwarded ex ante to primary emergency care due to local practice opening hours. Knowing the course (ex post), however, only 15.3% of the patients would have been.Conclusion: Our data show that the MTS is not a suitable instrument for safely steering patients to the outpatient sector.