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Christ et al justify the need for triage in Emergency Departments with the rising volumes and unpredictability of patient numbers. The review article describes triage systems which influence patient management processes by assessing how urgently treatment is needed. Acritical issue in such systems is the lack of medical specification.

Triage in theory provides a poorly evidence-based “harm free” waiting period until first contact with a doctor, but, for example, when applying the widely used Manchester Triage System (MTS) in acute stroke, patients are often allocated to category 3, “yellow”, with a permitted waiting time of 30 minutes. In reality, however, acute stroke is recognized in the ambulance (1), reported to the hospital before arrival, and the patient will be looked after by an emergency team immediately on arrival. In this context, using the MTS is not only superfluous but potentially dangerous. The same holds true for patients with chest complaints, who require an ECG within 10 minutes (2) even if they were triaged only as “yellow”.

The second critical aspect of triage is the mere fact that it is even necessary. This evidence of a lack of resources in clinical emergency medicine will not solve the issue but emphasizes it. Furthermore, triage is so far not included in the health insurance reimbursement schemes and has to be provided in addition to the usual services. In actual fact we have observed that when patient volumes are high, the triage times of the medium categories 3–5 cannot be adhered to and triage personnel is then often needed for immediate patient care.

Christ et al rightly state that patients increasingly choose the low-threshold emergency admission as their primary access route into healthcare services. Introducing regular “triage” of all emergency patients is a symptom of the problem of lacking resources in acute medicine.

DOI: 10.3238/arztebl.2011.0281a

Prof. Dr. med. Martin Möckel, FESC, FAHA

Notfallmedizin/Rettungsstellen/CPU

CharitéCentrum 13

Augustenburger Platz 1

13353 Berlin, Germany

Martin.Moeckel@charite.de

Conflict of interest statement

The author has received honoraria for acting as an adviser to Brahms, Bayer Healthcare, Securepoint, The Medicines Company. He has received honoraria for contracted clinical studies from Horizons-Ami and research funding from Brahms, Abbott Laboratories, and Bayer Healthcare.

1.
Royl G, Ploner CJ, Möckel M, Leithner C: Neurologische Leitsymptome in einer Notaufnahme. Nervenarzt 2010; 81: 1226–30. MEDLINE
2.
Möckel M, Vollert J, Hamm C, AG SOP Kardiologie: „Standard
operating procedures“ für den akuten ST-Streckenhebungsinfarkt. Anwendung prozessbasierter Grundsätze. Kardiologe 2010; 4: 124–34.
3.
Christ M, Grossmann F, Winter D, Bingisser R, Platz E: Modern
triage in the emergency department. Dtsch Arztebl Int 2010; 107(50): 892–8. VOLLTEXT
1.Royl G, Ploner CJ, Möckel M, Leithner C: Neurologische Leitsymptome in einer Notaufnahme. Nervenarzt 2010; 81: 1226–30. MEDLINE
2.Möckel M, Vollert J, Hamm C, AG SOP Kardiologie: „Standard
operating procedures“ für den akuten ST-Streckenhebungsinfarkt. Anwendung prozessbasierter Grundsätze. Kardiologe 2010; 4: 124–34.
3.Christ M, Grossmann F, Winter D, Bingisser R, Platz E: Modern
triage in the emergency department. Dtsch Arztebl Int 2010; 107(50): 892–8. VOLLTEXT