The other ED in Puolarmetsä is more like a traditional Finnish primary health care out-of-hours unit. There is no specialist care provided, and the laboratory and X-ray facilities

are available only during office hours. Puolarmetsä ED was not open during the night-time but only in the evenings and at weekends. Altogether, the data obtained from Jorvi and Puolarmetsä EDs were pooled together as Espoo ED’s data to study the effect on the patient currents in different main compartments of the local health care. Variables The data was obtained from the electronic health records of Espoo primary health care (Effica- patient chart system) and Jorvi secondary health care ED (Helsinki AZD8055 manufacturer University Inhibitors,research,lifescience,medical Central Hospital, HUCH; Oberon- patient chart system). The Social Insurance Institution of Finland (SII) provided the data about the use of the private Inhibitors,research,lifescience,medical primary health care doctors. In Espoo, the follow-up was performed between March 2004 and February 2008. The number of monthly visits to doctors was scored in each study department before and after implementation of the ABCDE triage system (1.3. 2007). Thus, we could study the situation before and after the implementation of ABCDE-triage in the EDs. In the case of those patients allocated to triage group E, the reasons for entry to Inhibitors,research,lifescience,medical the primary care EDs were recorded by using ICPC 2 (Finnish ICPC

2, 2010, http://www.kuntaliitto.fi) classification that was performed by the triage nurses. No ethical approval was required because this study was made directly from the

patient registry without Inhibitors,research,lifescience,medical identifying the patients. The registry keeper (health authorities Espoo and HUCH) granted permission to do the study. Intervention The intervention was part of a larger project aimed at improving the quality of ED services and reducing waiting times [16]. The leaders of the project analyzed the process. ABCDE-triage [16] was performed by experienced nurses in the frontline. Inhibitors,research,lifescience,medical Almost 60 nurses were educated by the medical directors (RM and JK) of the project to perform the ABCDE triage. These nurses assessed the patients before attending the doctor. The patients were triaged subjectively by the nurse as shown Non-specific serine/threonine protein kinase in Table ​Table1.1. During the first seven months, the non-urgent (group E) patients were given the option of waiting to be seen by the doctor, but without any promises about how long the waiting time would be. Later on, they were redirected home with self-care advice and advice to contact day-time services if the symptoms persisted. If the status of the patient altered in the waiting room a re-triage was performed. If a nurse was uncertain about her assessment she could ask for advice from a doctor or assess the patient in the higher triage group. Those patient groups who would need special attention were identified based on interviews with different specialists and stakeholders.