New triage system cuts prisoner visits to ERs, reduces threats against staff

A new Canadian triage system for prisoners with traumatic injuries has led to an almost four-fold decline in the number of prisoners being seen in the emergency departments at hospitals in Kingston, Ont., the Canadian Journal of Emergency Medicine (www.cma.ca/cjem/) reports in its July issue.

The system, introduced at the 9 prisons in and around Kingston, has also resulted in fewer threats and less violence against health professionals in emergency departments, as well as fewer escape attempts by prisoners.

The system employs a cadre of on-call community physicians to screen prisoner injuries via telephone. Verbal instructions are given to correctional officers or nurses. If necessary, the prisoner is seen on site by the physician or referred directly to the emergency department.

Prior to the system's introduction, all prisoners thought to have suffered traumatic injury in Kingston-area prisons were referred to 2 emergency departments in nearby hospitals. The new system has reduced the proportion of prisoners seen in these departments from an average of 6.1% of prisoners per year to 1.6%. The study also found that the “environment in the emergency department has improved and there has been a perceptible reduction in inmate-related incidents and threats against staff, patients and their families,” said Dr. Michael O'Connor of Queen's University, one of the study authors. He said the system might prove useful at other hospitals serving prison populations. — Barbara Sibbald, CMAJ