LNSLNS

We thank our colleagues for their comments. The studies cited by Wasser on the Manchester Triage System (MTS) were unfortunately published after our own literature search. These studies display relevant methodological problems (Martins et al: 91.7% self presentations, patients with admissions were excluded; Storm-Versloot et al: peracute and mild cases were excluded). The quality and reliability of the mentioned instruments depend on the prevalence of the disease and the relevant language and culture. This means that it is problematic to use them without adaptation to one’s own system (linguistic and cultural adaptation) and subsequent scientific validation. The MTS was developed at a time when mainly trauma patients were treated in emergency departments. In the United Kingdom, the MTS is now used in a modified version, since the patient cohorts have changed substantially and the MTS in its original form has relevant weaknesses, especially for elderly patients or patients with comorbidities. We therefore think it is necessary to evaluate instruments that are to be introduced de novo according to objectifiable criteria. This was done with the German translation and validation of the “Emergency Severity Index” (1).

Drawing comparisons to one’s own subjective experiences in obstetric practice is not helpful because such experiences are not objectifiable, and the range of possible diseases/injuries and the short time intervals between admissions (often every minute in our institutions) are not being considered. Clinical emergency medicine ranges from outpatient treatment by the general practitioner to complex care administered to severely injured patients including resuscitation. Excellent clinical emergency care can therefore be achieved only by division of labor and interdisciplinary working.

The term “triage” has been used and evaluated as a scientific term in emergency medicine for more than 30 years. Triage has always been linked to the overriding aim to optimize medical treatment (4), and not in order for triage staff to discharge or even refuse emergency patients. We showed that specially trained triage staff is able to perform their tasks correctly (no emergency patient of triage categories 4 or 5 has died [1]), and that this modern scientific concept has contributed to reducing mortality in outpatient acquired pneumonia (2).

We agree with Möckel that in view of rising patient volumes and increasing demands on emergency admissions, the current structures in Germany are placed under too much strain. If capacities for admissions exist then triaging is not strictly necessary. Triage will therefore often be used only when volumes reach a critical mass (3). Equipping staff and rooms adequately, and adapting processes in emergency departments continually is a conditio sine qua non, with or without professional nurse-driven triage.

DOI: 10.3238/arztebl.2011.0282b

Prof. Dr. med. Roland Bingisser

Universitätsspital

Petersgraben 4

CH-4056 Basel, Switzerland

Prof. Dr. med. Michael Christ

Prof. Ernst Nathan Str. 1

90419 Nürnberg, Germany

michael.christ@klinikum-nuernberg.de

Conflict of interest statement

The authors have received honoraria for acting as advisers from Roche AG, they have been reimbursed participation fees from for a symposium on atrial fibrillation, honoraria for speaking from Alexa GmbH, research grants from Roche AG, and third party funding from the Swiss Paraplegics Foundation.

1.
Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R: Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med 2010 (in press). MEDLINE
2.
Christ M, Dodt C, Geldner G, Hortmann M, Stadelmeyer U, Wulf H: Presence and future of emergency medicine in Germany. Anasthesiol Intensivmed Notfallmed Schmerzther 2010; 45: 666–71. MEDLINE
3.
Wiler JL, Gentle C, Halfpenny JM, et al.: Optimizing emergency department front-end operations. Ann Emerg Med 2010; 55: 142–60. e1. MEDLINE
4.
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.Grossmann FF, Nickel CH, Christ M, Schneider K, Spirig R, Bingisser R: Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med 2010 (in press). MEDLINE
2. Christ M, Dodt C, Geldner G, Hortmann M, Stadelmeyer U, Wulf H: Presence and future of emergency medicine in Germany. Anasthesiol Intensivmed Notfallmed Schmerzther 2010; 45: 666–71. MEDLINE
3. Wiler JL, Gentle C, Halfpenny JM, et al.: Optimizing emergency department front-end operations. Ann Emerg Med 2010; 55: 142–60. e1. MEDLINE
4.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