IMPROVING TRIAGE ACCURACY
Building on our heterogeneity findings, which help us understand the mechanisms of utilization behavior, our research developed a method of identifying high-risk patients with greater reliability and validity than the conventional wisdom, to improve the accuracy of triage and resource allocation in the emergency department (ED). Triage helps decision makers decide who needs medical attention most urgently, presentation to the ED is not determined on a first come first serve basis. Our research sought technical improvements in the ability to affect queuing and ultimately the quality and efficiency of care, reducing morbidity and mortality and improving well-being for patients, hospitals and society.
Our study found that conventional triage assessment scales used in many EDs across the country was 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) had admission/ED death rates of 76% and 43%, respectively. In contrast, the 2 lowest acuity categories (D and E) had admission/ED death rates of 1% or less. The middle category (C), however, had 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. We found that 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. Our findings suggested 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.