SHORT REPORT Analysis of effectiveness and safety of a three-part triage system for the access to dermatology specialist health care J. Deluca, 1 A. Goldschmidt, 2 K. Eisendle 1, * 1 Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Innsbruck Medical University, Central Hospital, Bolzano, Bolzano/Bozen, Italy 2 International Health Care Management Institute, University Trier, Trier, Germany *Correspondence: K. Eisendle. E-mail: Klauseisendle@hotmail.com Abstract Background Accessibility and waiting times pose a general problem in public financed health care systems. In Italy a three-part triage system (urgent, priority and deferrable with a corresponding maximum time target before treatment of 1, 8 and 60 days respectively) to gain faster treatment for urgent and emergent cases of dermatology outpatients has been introduced. Methods From February 2011 to August 2013, samples of 1526 outpatient electronic medical record cases were randomly retrieved. Diagnoses with their corresponding triage codes were recorded. Urgent visits were further anal- ysed according to the referring physician. The appropriateness of the referral was based on the published state law diagnostic guidelines. Data were statistically analysed using the 2-tailed Pearson chi-squared test or the Fisher exact test. Results Overall, 56.5% retrieved cases were deferrable, 13.1% priority and 30.4% urgent. Frequency of diagnoses differed significantly between the three groups (P < 0.05). Appropriateness of the triage level was higher for priority than for urgent referrals (P < 0.05%). An overestimation of urgency levels was noted and urgent cases were not overseen. Triage levels were best assessed by general practitioners (75% correct allocations) followed by emergency physicians (59%) and other specialists (45%) (P < 0.01%). Conclusion The triage system according to clinical need is safe. Correct allocation according to urgency occurs in <75% and leaves space for improvement. General Practitioners address patient 0 s access significantly better than other physicians, therefore are best suited to function as gatekeepers to the access of specialist care in public funded health care systems. Received: 12 February 2015; Accepted: 18 May 2015 Conflicts of interest None Funding source None. Introduction Accessibility and waiting times pose a general problem in public financed health care systems. The demand for referrals to spe- cialist visits and diagnostic procedures in Italy has been rising in recent years, making access to these services difficult. 1–3 To address outpatients’ access according to the National directives in 2003, the Local Health Unit of Bolzano adopted the three-part Homogenous Waiting Groups (HWGs) triage system, where access to specialist dermatology visits is divided into urgent, pri- ority and deferrable, with a corresponding maximum waiting time target from referral to consultation of 1, 8, and 60 days, respectively. The main goal of HWGs is to redistribute outpa- tient referrals on the basis of clinical need according to profes- sional judgement, in order to gain faster treatment for urgent or emergent cases. 4 Prerequisite to implement this strategy is build- ing consensus between general practitioners (GP) and special- ists. 5,6 Medical conditions that allow a priority or urgent access to specialist health care are defined by law (Table 1). In order to implement a proper use of the triage codes, prescription guideli- nes have been listed in structured referral sheets which have been sent to the GP, emergency departments and other specialists. To make a referral, the GP or other specialists must complete a © 2015 European Academy of Dermatology and Venereology JEADV 2016, 30, 1190–1194 DOI: 10.1111/jdv.13295 JEADV