Abstract
ObjectivesThe aim of this study was to investigate the long-term effect of a teaching intervention designed to reduce undertriage rates in older ED patients. Further, to test the hypothesis that non-adherence to the Emergency Severity Index (ESI) triage algorithm is associated with undertriage. Additionally, to detect patient related risk factors for undertriage.MethodsPre-post-test design. The study sample consisted of all patients aged 65 years or older presenting to the ED of an urban tertiary and primary care center in the study periods. A teaching intervention designed to increase adherence to the triage algorithm. To assess, if the intervention resulted in an increase of factual knowledge, nurses took a test before and immediately after the teaching intervention. Undertriage rates were assessed one year after the intervention and compared to the pre-test period.ResultsIn the pre-test group 519 patients were included, and 394 in the post-test-group. Factual knowledge among triage nurses was high already before the teaching intervention. Prevalence of undertriaged patients before (22.5%) and one year after the intervention (24.2%) was not significantly different (χ2 = 0.248, df = 1, p = 0.619). Sex, age, mode of arrival, and type of complaint were not identified as independent risk factors for undertriage. However, undertriage rates increased with advancing age. Adherence to the ESI algorithm is associated with correct triage decisions.ConclusionsUndertriage of older ED patients remained unchanged over time. Reasons for undertriage seem to be more complex than anticipated. Therefore, additional contributing factors should be addressed.
Highlights
Undertriage, an assignment of an inadequately low triage level, increases the patients’ risk for health status deterioration while waiting
Of these 3 patients were referred from other hospitals, 6 records were not available, and 108 patients had no Emergency Severity Index (ESI) level assigned,; In the final analysis, 394 patients were included
Characteristics of both groups are shown in table 1: The proportion of ESI levels differs significantly between the pre- and the post-test period for ESI level 1, 2, and 3 (Pearson’s x2 test with Yate’s continuity correction) with ESI 1 and 2 being more and ESI 3 being less prevalent in the post-test period
Summary
Undertriage, an assignment of an inadequately low triage level, increases the patients’ risk for health status deterioration while waiting. Older ED patients are a vulnerable patient group and are at risk of undertriage [2,3]. Reasons for this are poorly understood, but likely are multifactorial. The interpretation of vital signs, for instance, is more difficult in older patients, as they may be normal even in serious disease [4,5,6]. Older ED patients often present with nonspecific complaints such as weakness [7], which may lead to undertriage [8]
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