Identifying High-Risk Patients for Triage and Resource Allocation in the ED

American Journal of Emergency Medicine, Vol. 25, pp. 794-798, 2007

5 Pages Posted: 28 Oct 2007

See all articles by Jennifer Prah Ruger

Jennifer Prah Ruger

University of Pennsylvania - School of Social Policy & Practice; University of Pennsylvania - Perelman School of Medicine

Lawrence Lewis

Washington University in St. Louis - School of Medicine

Christopher Richter

Washington University in St. Louis - School of Medicine

Abstract

Five-point triage assessment scales currently used in many emergency departments (EDs) across the country have been shown to be accurate and reliable. We have found the system to be highly predictive of outcome (hospital admission, intensive care unit/operating room admission, or death) at either extreme of the scale but much less predictive in the middle triage group. This is problematic because the middle triage acuity group is the largest, in our experience comprising almost half of all patients. Patients triaged to the 2 highest acuity categories (A and B) have admission/ED death rates of 76% and 43%, respectively. In contrast, the 2 lowest acuity categories (D and E) have admission/ED death rates of 1% or less. The middle category (C), however, has an overall admission/ED death rate of 10%, too high to be comfortable with prolonged delays in the ED evaluation of these patients. We studied this group to determine if easily obtainable clinical factors could identify higher-risk patients in this heterogeneous category. Data were obtained from a retrospective, cross-sectional study of all patients seen in 2001 at an urban academic hospital ED. The main outcome measure for multivariate logistic regression models was hospital admission among patients triaged as acuity C. Acuity C patients who were 65 years or older, presenting with weakness or dizziness, shortness of breath, abdominal pain, or a final diagnosis related group diagnosis of psychosis, were more likely to be admitted than patients originally triaged in category B. These findings suggest that a few easily obtainable clinical factors may significantly improve the accuracy of triage and resource allocation among patients assigned with a middle-acuity score.

Keywords: triage, assessments, emergency departments

JEL Classification: I10, I31

Suggested Citation

Prah Ruger, Jennifer and Lewis, Lawrence and Richter, Christopher, Identifying High-Risk Patients for Triage and Resource Allocation in the ED. American Journal of Emergency Medicine, Vol. 25, pp. 794-798, 2007. Available at SSRN: https://ssrn.com/abstract=1024785

Jennifer Prah Ruger (Contact Author)

University of Pennsylvania - School of Social Policy & Practice ( email )

3701 Locust Walk
Philadelphia, PA 19104-6214
United States

University of Pennsylvania - Perelman School of Medicine

423 Guardian Drive
Philadelphia, PA 19104
United States

Lawrence Lewis

Washington University in St. Louis - School of Medicine ( email )

St. Louis, MO
United States

Christopher Richter

Washington University in St. Louis - School of Medicine ( email )

St. Louis, MO
United States

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