Do the Canadian Triage Guidelines Identify the Urgency of Oncological Emergencies

Abstract

Background: Triage in an emergency department (ED) plays a pivotal role as the volume of ED visitors is unpredictable. All ED patients are triaged to make sure that patients with urgent or life-threatening conditions are seen immediately while others with more stable conditions are safe to wait. Purpose: To examine the Canadian Triage and Acuity Scale (CTAS) guidelines to determine if the urgency of oncological emergencies can be prioritized appropriately using the CTAS guidelines. Methods: We used the Complaint Oriented Triage (COT 2012), which is an interactive computerized CTAS tool, to triage select oncological emergencies; superior vena cava syndrome, cardiac tamponade, tumor lysis syndrome, and febrile neutropenia. Results: Patients with cancer have a higher acuity compared to many other ED patients. However, most of the oncological emergencies can be subtle and nonspecific. The CTAS guidelines need to be strengthened to better represent the urgency of these life-threatening conditions. Conclusion: Although revisions have been implemented and the reliability of the CTAS tool has improved, the guidelines are designed to be generic and cannot address every health situation. Febrile neutropenia is an excellent example of the additional supports needed at triage to accurately determine the patient’s health status. Knowledge of the signs and symptoms of these emergencies will enable triage nurses to accurately differentiate the urgency of the different presenting complaints. Formalized education that prepares triage nurses to better understand the complexity of the symptom presentation and the needed care for patients with different oncological emergencies is essential.