Stronger scientific evidence is needed to determine which of the vital signs and chief complaints have the greatest prognostic value in the triage. Patients may have a life-threatening condition, but show normal vital signs. Inter rater agreement (reliability), validity, and safety of triage scales need to be investigated further, and head-to-head comparisons are needed to determine whether any of the triage scales have advantages over others [29]. Nevertheless, the quality of triage assessment must be continuously monitored and the number of incorrect Inhibitors,research,lifescience,medical assessments

minimized. Right now further studies are ongoing on the safety of the present ABCDE-triage system and also on the changes in waiting time associated with triage. It would also be interesting to know more about the patient flows, such as the destination of the patients, and whether these flows changed after implementation of the ABCDE triage. With destination is here meant patient flows to secondary ED, hospital admissions, patients Inhibitors,research,lifescience,medical treated at the primary ED and then sent home, or sent home immediately (= urgency group E). This Inhibitors,research,lifescience,medical lack of information is a considerable limitation of our study. We are planning to perform studies aimed to reveal above mentioned patient flows more profoundly in the future. Conclusion Implementation

of ABCDE-triage combined with public guidance was associated with a reduction in the use of a primary health care ED services. This intervention did not seem to increase the workload during office hours in the public primary health care or in secondary health care.

Strict ABCDE-triage Inhibitors,research,lifescience,medical combined with public guidance may decrease total use of public primary health care and redirect part of the patients to the private sector. List of abbreviations ED: Emergency department; GP: General practitioner. Competing interests The authors declare that they have no competing interests. Authors’ contributions JaK led and performed the intervention planned the analysis and wrote the manuscript. RM led and performed the intervention and arranged the data from Espoo. TH led and performed the intervention. Inhibitors,research,lifescience,medical JM arranged the data from tertiary health care. KJM planned the analysis else and wrote the manuscript. TK arranged the data from the private sector, analyzed the data, planned the experimental setting and wrote the manuscript. All the authors have read and check details approved the final manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-227X/12/2/prepub Acknowledgements The authors wish to thank the two referees for improving considerably the quality of the present report.
In the past 30 years, the number of visits to emergency departments (EDs) has increased, inducing overcrowding in many countries [1]. ED overcrowding is related to multiple complex problems: overburdened inpatient facilities, inadequate ED space, insufficient staffing, and inaccessibility to primary care services [2-6].