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Parliamentary ombudsman proposes national triage guidlines

A young child suspected of having a foreign body in the respiratory tract had to wait for over an hour to see a doctor at a health centre's emergency service.

Parliamentary Ombudsman Petri Jääskeläinen proposes that the National Supervisory Authority for Welfare and Health Valvira should consider the need to develop clear national triage guidelines. The Parliamentary Ombudsman finds such guidelines vital in order to safeguard patient safety, patient equality and continuity of care.
 
The Parliamentary Ombudsman commented on the matter as a result of a complaint filed with him.

A one-year-old child suspected of having a foreign body in the respiratory tract was brought to the health centre emergency service. The child's need for care was assessed to be non-urgent. The child had to wait for an hour to be examined by a doctor.

According to statements obtained by the Parliamentary Ombudsman from Valvira and its permanent expert, a young child suspected of having a foreign body in their throat or respiratory tract should be treated urgently. Even if the patient's status were good, it is possible that the body is inhaled deeper into the respiratory tract.

Triage refers to a preliminary assessment of how urgently care should be administered to a patient. The triage classification of the health centre did not have a rule stating that a suspected foreign body in the respiratory tract was a case needing urgent treatment.

Of Finnish triage classifications examined by Valvira's permanent expert, only the one applied in the Northern Karelia Central Hospital specifically refers to a suspected foreign body in the respiratory tract as belonging to urgency class A or B. The patient must be seen by a doctor within 10 minutes.

According to Parliamentary Ombudsman Jääskeläinen, the preliminary assessment of urgency should be consistent at various emergency units to ensure that the patients are not treated differently in triage assessment depending on where they are treated. It appears that there are differences in the triage classifications of such cases as a suspected foreign body in the respiratory tract, which is not acceptable.
 
As a separate issue, local triage guidelines may include more detailed instructions related to division of labour and treatment. More specific triage legislation or national guidelines do not exist.

The full text of decision no 2704/4/13 (in Finnish).