Abstract
Background and objectiveEmergency departments (EDs) often find the number of arriving patients exceeding their capacity and find it difficult to triage them in a timely manner. The potential risk to the safety of patients awaiting assessment by a triage professional has led some hospitals to consider implementing patient self-triage, such as using kiosks. Published studies about patient self-triage are scarce and information about patients’ ability to accurately assess the acuity of their condition or predict their need to be hospitalized is limited. In this study, we aimed to compare computer-assisted patient self-triage scores versus the scores assigned by the dedicated ED triage nurse (TN).MethodsThis pilot study enrolled patients presenting to a tertiary care hospital ED without ambulance transport. They were asked a short series of simple questions based on an algorithm, which then generated a triage score. Patients were asked whether they were likely to be admitted to the hospital. Patients then entered the usual ED system of triage. The algorithm-generated triage score was then compared with the Canadian Triage and Acuity Scale (CTAS) score assigned by the TN. Whether the patients actually required hospital admission was determined by checking their medical records.ResultsAmong the 492 patients enrolled, agreement of triage scores was observed in 27%. Acuity was overestimated by 65% of patients. Underestimation of acuity occurred in 8%. Among patients predicting hospitalization, 17% were admitted, but the odds ratio (OR) for admission was 3.4. Half of the patients with cardiorespiratory complaints were correct in predicting the need for hospitalization.Conclusion The use of a short questionnaire by patients to self-triage showed limited accuracy, but sensitivity was high for some serious medical conditions. The prediction of hospitalization was more accurate with regard to cardiorespiratory complaints.
Highlights
Emergency department (ED) overcrowding is a problem experienced in hospitals worldwide, including North America [1,2]
Our results show a relatively poor agreement between algorithm-generated self-triage score (AGST) scores by patients and Canadian Triage and Acuity Scale (CTAS) scores assigned by a triage nurse (TN)
Asking patients to triage themselves has been proposed as a method to address safety concerns for patients waiting to see a TN and to improve the throughput of patients
Summary
Emergency department (ED) overcrowding is a problem experienced in hospitals worldwide, including North America [1,2]. It results in prolonged waiting times for patients arriving in EDs, increasing the risk of poor clinical outcomes for the sickest patients [3]. All busy EDs utilize triage scoring systems to help decide which patients are at higher risk of poor outcomes among those who are waiting to be assessed and treated. Published studies about patient self-triage are scarce and information about patients’ ability to accurately assess the acuity of their condition or predict their need to be hospitalized is limited. We aimed to compare computer-assisted patient self-triage scores versus the scores assigned by the dedicated ED triage nurse (TN)
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