Patient Prioritization in Emergency Department Triage Systems: An Empirical Study of Canadian Triage and Acuity Scale (CTAS)

41 Pages Posted: 10 Oct 2016 Last revised: 7 Mar 2018

See all articles by Yichuan Ding

Yichuan Ding

Desautels Faculty of Management, McGill University

Eric Park

The University of Hong Kong - Faculty of Business and Economics

Mahesh Nagarajan

University of British Columbia (UBC) - Sauder School of Business

Eric Grafstein

Providence Health Care and Vancouver Coastal Health - Department of Emergency Medicine & Health

Date Written: January 12, 2018

Abstract

Emergency departments (EDs) typically use a triage system to classify patients into priority levels. However, most triage systems do not specify how exactly to route patients within the assigned triage levels, hence, decision makers in EDs often have to use their own discretion to route patients. Also, how patient waiting is perceived and accounted for in ED operations is not clearly understood. In this paper, we identify the ED patient waiting cost structure perceived by the ED patient-routing decision maker, based on patient ED visit data, and derive policy implications and make suggestions for improving triage systems.

We analyze the patient routing behaviors of ED decision makers in four EDs in the metro Vancouver, British Columbia area. They all use the Canadian Triage and Acuity Scale (CTAS), which has a wait time-related target service level objective. We propose a general discrete choice framework, consistent with queueing literature, as a tool to analyze prioritization behaviors in multi-class queues under mild assumptions. We find that the decision makers in all four EDs 1) apply a delay-dependent (dynamic) prioritization across different triage levels; 2) have a perceived marginal ED patient waiting cost that is best fit by a piece-wise linear concave function in wait time; 3) generally follow, in the same triage level, the first-come first-served (FCFS) principle, but their adherence to the principle decreases for patients who wait past a certain threshold; and 4) do not use patient-complexity as a major criterion in prioritization decisions.

Keywords: Triage, Emergency Department, Multi-class Queue, Dynamic Priority, Discrete Choice, Public Policy

Suggested Citation

Ding, Yichuan and Park, Eric and Nagarajan, Mahesh and Grafstein, Eric, Patient Prioritization in Emergency Department Triage Systems: An Empirical Study of Canadian Triage and Acuity Scale (CTAS) (January 12, 2018). Available at SSRN: https://ssrn.com/abstract=2843932 or http://dx.doi.org/10.2139/ssrn.2843932

Yichuan Ding (Contact Author)

Desautels Faculty of Management, McGill University ( email )

1001 Sherbrook St W
Montreal, Quebec H3A 1G5
Canada
5143982482 (Phone)

HOME PAGE: http://https://www.mcgill.ca/desautels/yichuan-daniel-ding

Eric Park

The University of Hong Kong - Faculty of Business and Economics ( email )

Pokfulam Road
Hong Kong
China

Mahesh Nagarajan

University of British Columbia (UBC) - Sauder School of Business ( email )

2053 Main Mall
Vancouver, BC V6T 1Z2
Canada

Eric Grafstein

Providence Health Care and Vancouver Coastal Health - Department of Emergency Medicine & Health ( email )

1081 Burrard St
Vancouver, BC V6Z 1Y6
Canada

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