To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC).
Unblinded randomised controlled trial with ...weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard).
In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised.
ED nurses using a new tool safely diverted 9.5% of the included patients to primary care.
ClinicalTrials.gov Identifier: NCT03793972.
During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients ...had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-compliance and its impact on costs, as charged on the patient's invoice.
Bivariate analyses with logistic regressions and T-tests were used to test the differences in patient characteristics, patient status, timing characteristics, and costs between refusers and non-refusers. A chi-square automatic interaction detection analysis was used to find the predictors of non-compliance.
23.50% of the patients refused the advice to visit the general practitioner cooperative. This proportion was mainly influenced by the nurse on duty (non-compliance rates per nurse ranging from 2.9% to 52.8%) and the patients' socio-economic status (receiving increased reimbursement versus not OR 1.37, 95%CI: 0.96 to 1.95). Additionally, non-compliance was associated (at the 0.10 significance level) with being male, not living nearby and certain reasons for encounter. Fewer patients refused when the nurse perceived crowding level as quiet relative to normal, and more patients refused during the evening. The mean cost was significantly higher for patients who refused, which was a result of more extensive examination and higher out-of-pocket expenses at the ED.
The nurse providing the advice to visit the general practitioner cooperative has a central role in the likelihood of patients' refusal. Interventions to reduce non-compliance should aim at improving nurse-patient communication. Special attention may be required when managing patients with a lower socio-economic status. The overall mean cost was higher for refusers, illustrating the importance of compliance.
The trial was registered on registration number NCT03793972 on 04/01/2019.
ObjectivesIn the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage ...System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC.SettingED of a general hospital and the adjacent GPC.Participants8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations.ResultsAn additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01).ConclusionNurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients.Trial registration numberNCT03793972.
Purpose This paper aims to highlight the expanding link between facility management (FM) and building automation and control systems (BACS) through a review of literature. It examines the ...opportunities and challenges of BACS for facility managers and proposes solutions for mitigating the risks associated with BACS implementation. Design/methodology/approach This paper reviews various research papers to explore the positive influences of BACS on FM, such as support with strategic decision-making, predictive maintenance, energy efficiency and comfort improvement. It also discusses the challenges of BACS, including obsolescence, interoperability, vendor lock-in, reliability and security risks and suggests potential solutions based on existing literature. Findings BACS offers numerous opportunities for facility managers, such as improved decision-making, energy efficiency and comfort levels in office buildings. However, there are also risks associated with BACS implementation, including obsolescence, interoperability, vendor lock-in, reliability and security risks. These risks can be mitigated through measures such as hardware and software obsolescence management plans, functional requirement lists, wireless communication protocols, advanced feedback systems and increased awareness about BACS security. Originality/value To the best of the authors’ knowledge, no prior academic research has been conducted on the expanding link between FM and BACS. Although some papers have touched upon the opportunities and challenges of BACS for FM, this paper aims to provide a comprehensive overview of these findings by consolidating existing literature.
Objectives To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). Methods Unblinded randomised ...controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). Results In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. Conclusions ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. Trial registration ClinicalTrials.gov Identifier: NCT03793972
•First randomised cost effects study about diverting ED patients to primary care.•Total costs increased 3% (€3.3) by the intervention.•Costs decreased 8% (€2.2) for the patient and increased 6% ...(€5.5) for the insurance.•Primary care revenues increased 13%; no reduction found for the emergency department.•A financial evaluation is necessary for each healthcare system considering extended triage.
During the TRIAGE trial, emergency nurses diverted 13.3% of patients with low-risk complaints from a Belgian emergency department (ED) to the adjacent general practitioner cooperative (GPC). We examined the effects of this diversion on the total cost, insurance costs and patient costs, as charged on the invoice. Changes in the cost composition and the direct impact on revenues of both locations were examined as a secondary objective.
The differences in costs between intervention and control weekends were tested with two-sample t-tests and Kolmogorov-Smirnov (KS) tests. For the main outcomes an additional generalised linear model was created. Proportions of patients charged with certain costs were examined using Pearson's chi-square tests. Average revenues per weekend were compared using pooled t-tests.
During intervention weekends, total costs increased by 3% (€3.3). The costs decreased by 8% (€2.2) for patients and increased by 6% (€5.5) for insurance, mainly driven by differences in physician fees. More patients were charged a consultation fee only (25% vs. 19%, p-value<0.01). The GPC's revenues increased by 13% (p-value=0.06); no change was found for the ED's revenues.
The intervention reduced costs slightly for patients, while total costs and insurance costs slightly increased. When implementing triage systems with primary care involvement, the effects on the costs and revenues of the stakeholders should be monitored.
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Although Technology Transfer as a research topic has become more and more popular, the mission and vision statements of technology transfer offices (TTOs) and the impact they have on the technology ...transfer processes leading to the creation of spin-offs, is still unfamiliar terrain. As mission and vision are incorporated into the operational philosophy of a TTO, this paper aims to find out what operational philosophies currently exist and if they can be aggregated into a typology. An empirical study was performed through a survey of 51 European TTOs, representing different academic disciplines and affiliations. The results shows that currently, three operational philosophy types exist within European TTOs: Cash, Community and Cooperation. Consequently, the degree to which the licensing negotiation strategies for the creation of spin-offs matched the typology that TTOs proclaimed to adhere to was studied. The results show that, besides mission and vision, also the risk averseness of TTOs plays a major role in the operational philosophy.
Objectives To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). Methods Unblinded randomised ...controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). Results In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. Conclusions ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. Trial registration ClinicalTrials.gov Identifier: NCT03793972
Information and knowledge have become precious goods in the transitional era toward knowledge-intensive economies. However, protection of confidential information has become a topic of major concern. ...Confidentiality and the use of the non-disclosure agreement (NDA) are topics touching and influencing day-to-day business life. This study aims to provide a practical overview of the most common and most requisite elements of the NDA within the framework of the technology transfer process, beyond the borders of industry sector or country. The evolution of the content of the average NDA is analyzed, and reflection on the rather unusual elements reveals interesting topics for discussion.
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