Emergency department (ED) overcrowding is a growing issue, affecting patient safety, healthcare quality, and hospital efficiency. One strategy to manage low-acuity patients is triage-based redirection, where patients with non-urgent conditions are offered the option to receive care at external medical facilities instead of the ED.
This monocentric, prospective observational study will be conducted at Fribourg Cantonal Hospital, Switzerland, and evaluates the impact of a new electronic triage and redirection system (Logibec Réorientation). The study compares two triage processes:
Current practice - Redirection based on the Swiss Emergency Triage Scale (SETS), limited to low-acuity patients (SETS 4).
New practice - Redirection using the Logibec software, allowing redirection of both low-acuity (SETS 4) and semi-urgent (SETS 3) patients based on predefined criteria.
The primary objective is to assess whether the new triage-based redirection reduces the number of ED consultations per patient within 48 hours of their initial visit.
Secondary outcomes include:
Number of consultations in the ED or other medical facilities within 7 days Rate of hospital admissions within 7 days Patient satisfaction with redirection Evolution of health literacy over 6 months Number of ED visits over 6 months Participants are adult patients (≥18 years old) classified as SETS 3-4 and identified as eligible for redirection by the Logibec software. Data will be collected through phone interviews and questionnaires over a 6-month follow-up period.
This study aims to improve triage efficiency, patient flow management, and healthcare accessibility, while ensuring patient safety in the redirection process.
Age ≥18 years old
Triage level SETS 3 or SETS 4 (classified as semi-urgent or low-acuity)
Identified as eligible for redirection by the Logibec electronic triage system
Able to speak and read French or German (for informed consent and follow-up)
Inability to provide informed consent (e.g., cognitive impairment, language barrier without translation support)
Inability to comply with study procedures, such as: Severe hearing impairment without hearing aids; Acute psychiatric conditions preventing participation; Not available for follow-up phone calls within the next 6 months
Participants will be selected from adult patients (≥18 years old) seeking care at the Emergency Department (ED) of Fribourg Cantonal Hospital, Switzerland. This population consists of patients who: * present diverse medical complaints typically classified as with low-acuity (SETS 4) or semi-urgent (SETS 3) conditions as determined by the Swiss Emergency Triage Scale (SETS). * Are evaluated for potential redirection by ED triage nurse using the Logibec electronic triage system and may benefit from this triage-based redirection rather than hospital-based emergency care * Require non-urgent medical care that can be managed outside the hospital setting * French- or German-speaking individuals (for informed consent and follow-up participation)
Cohort
Prospective
intervention is the use of aTriage-Based Patient Redirection Using an Electronic Decision Support Toolin the emergency department (ED)
Other interventionName: Logibec Réorientation software-assisted triage and redirection Type: Decision support system for emergency triage Implementation: * Applied during patient triage in the emergency department * Assists in identifying low-acuity (SETS 4) and semi-urgent (SETS 3) patients eligible for redirection * Uses standardized inclusion/exclusion criteria to guide redirection decisions Comparator: Standard nurse-led triage and redirection based only on the Swiss Emergency Triage Scale (SETS) Key Distinction: * The investigated group receives Logibec-assisted triage and redirection. * The comparator group follows traditional nurse-led triage without electronic support, limiting redirection to SETS 4 patients only.
Number of Emergency Department Consultations per Patient Within 48 Hours After Initial Visit
This measure refers to the total number of emergency department (ED) visits per patient within 48 hours following their initial presentation to the ED. The first consultation at the ED is counted as the initial visit. 1. Any subsequent unplanned return visits to the ED within 48 hours of the initial visit are included in the count. 2. Data collection is conducted through electronic health records (EHR) review and patient follow-up phone calls. This outcome aims to assess whether electronic triage-assisted redirection is effective, by providing service through alternative health care providers ,without patients needing further ED care
the number of consultations per patient in the ED or other medical services within 7 days after the first ED visit
the proportion of patients who need hospitalization related to initial complaint within 7 days
the proportion of patients satisfied with the redirection process
Patient satisfaction as assessed by satisfaction questionnaire
the mean number of ED consultations after 1 month, 3 months and 6 months per patient
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Hôpital Fribourgeois
Lead sponsor
University of Fribourg
Collaborator
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