Canadian Triage And Acuity Scale Research Articles

Analyzing Non-urgent Emergency Department Visits: Patterns, Demographics, Motivations, and Triage System Awareness in Al-Qassim.

This cross-sectional descriptive study aimed to ascertain the prevalence of non-urgent cases, investigate gender and age preferences, and explore factors influencing individuals' selection of the emergency department (ED) for non-urgent cases in the Al-Qassim region of Saudi Arabia. From July 15, 2022, to December 31, 2022, a structured online questionnaire via a Google Docs survey collected data. The study sampled 425 patients from two prominent Al-Qassim healthcare institutions: Buraydah King Fahad Specialized Hospital and Buraydah Central Hospital. Encompassing patients aged 20 to 80 admitted to the ED between 8:00 and 16:00, concurrent with primary healthcare center availability, the study categorized participants by urgency using the Canadian Triage and Acuity Scale (CTAS) criteria. Data analysis employed descriptive statistics, chi-square tests, and probit regression in R version 4.3.3, with a significance level of p< 0.05 for result interpretation. In Al-Qassim in 2022, 82.4% of ED visitors sought care for non-urgent cases, while 17.6% sought care for urgent cases. No statistically significant relationship was found between age and gender and urgent ED visits. Among those with non-urgent conditions, the top reasons for bypassing primary healthcare services were slow treatment (52.7%), lack of knowledge about primary healthcare (PHC) services (33.9%), and appointment unavailability (5.5%). Evaluation of awareness of the ED triage system showed a significant difference only among patients with excellent awareness. The investigation found a higher prevalence of non-urgent cases, especially among females. Challenges in appointment booking, accessibility, and the perception of urgency were key factors leading patients to choose the emergency department over PHC centers. The study emphasized the crucial role of ED triage system awareness and the impact of satisfaction with PHC services on healthcare-seeking behavior, with younger individuals less likely to visit the ED and males more inclined at specific satisfaction levels.

Descriptive analysis and evaluation of Health Link referrals to the emergency department before and during the COVID-19 pandemic.

In Alberta, Health Link (HL) provides a 24-h, nurse-staffed, phone resource to the public for health-care advice. HL directs callers to either seek care in the emergency department (ED), with a primary care provider or provide self-care at home. This work aims to describe HL ED referrals prior to and during the COVID-19 pandemic. Data from January 1, 2018-December 31, 2019, and July 1, 2020-June 30, 2022, were selected. HL calls were categorized as likely appropriate if the patient was referred and presented to the ED within 24h and had a Canadian Triage and Acuity Scale (CTAS) of 1-3; or a CTAS of 4-5 and the patient was admitted, specialist consulted, or diagnostic imaging or laboratory tests were completed. The primary outcome was the percentage of likely appropriate referrals among all HL ED referrals. In the 2018-2019 and 2020-2022 samples, respectively, there were 845,372 and 832,730 calls. Of the 211,723 and 213,486 ED referrals, only 140,614 (66.4%) and 143,322 (67.1%) presented to an ED. Of these, 84.3 and 86.7 per 100 patient visits were categorized as likely appropriate referrals. Health Link referrals account for 3.2% and 3.8% of all ED visits. HL referrals to the ED represent only a small percentage of all ED visits. Based on our definition, most referrals by HL are likely appropriate. The COVID-19 pandemic does not appear to have altered the rates of calls to HL, the number of HL calls referred to the ED, nor the likely appropriateness of those referrals.

Repeatability, reproducibility, and diagnostic accuracy of a commercial large language model (ChatGPT) to perform emergency department triage using the Canadian triage and acuity scale.

The release of the ChatGPT prototype to the public in November 2022 drastically reduced the barrier to using artificial intelligence by allowing easy access to a large language model with only a simple web interface. One situation where ChatGPT could be useful is in triaging patients arriving to the emergency department. This study aimed to address the research problem: "can emergency physicians use ChatGPT to accurately triage patients using the Canadian Triage and Acuity Scale (CTAS)?". Six unique prompts were developed independently by five emergency physicians. An automated script was used to query ChatGPT with each of the 6 prompts combined with 61 validated and previously published patient vignettes. Thirty repetitions of each combination were performed for a total of 10,980 simulated triages. In 99.6% of 10,980 queries, a CTAS score was returned. However, there was considerable variations in results. Repeatability (use of the same prompt repeatedly) was responsible for 21.0% of overall variation. Reproducibility (use of different prompts) was responsible for 4.0% of overall variation. Overall accuracy of ChatGPT to triage simulated patients was 47.5% with a 13.7% under-triage rate and a 38.7% over-triage rate. More extensively detailed text given as a prompt was associated with greater reproducibility, but minimal increase in accuracy. This study suggests that the current ChatGPT large language model is not sufficient for emergency physicians to triage simulated patients using the Canadian Triage and Acuity Scale due to poor repeatability and accuracy. Medical practitioners should be aware that while ChatGPT can be a valuable tool, it may lack consistency and may frequently provide false information.

Trend of mortality and length of stay in the emergency department following implementation of a centralized sepsis alert system.

Sepsis alerts based on laboratory and vital sign criteria were found insufficient to improve patient outcomes. While most early sepsis alerts were implemented into smaller scale operating systems, a centralized new approach may provide more benefits, overcoming alert fatigue, improving deployment of staff and resources, and optimizing the overall management of sepsis. The objective of the study was to assess mortality and length of stay (LOS) trends in emergency department (ED) patients, following the implementation of a centralized and automated sepsis alert system. The automated sepsis alert system was implemented in 2021 as part of a hospital-wide command and control center. Administrative data from the years 2018 to 2021 were collected. Data included ED visits, in-hospital mortality, triage levels, LOS, and the Canadian Triage and Acuity Scale (CTAS). Mortality rate for patients classified as CTAS I triage level was the lowest in 2021, after the implementation of the automated sepsis alert system, compared to 2020, 2019, and 2018 (p < 0.001). The Kaplan-Meier survival curve revealed that for patients classified as CTAS I triage level, the probability of survival was the highest in 2021, after implementation of the sepsis alert algorithm, compared to previous years (Log Rank, Mantel-Cox, χ²=29.742, p < 0.001). No significant differences in survival rate were observed for other triage levels. Implementing an automated sepsis alert system as part of a command center operation significantly improves mortality rate associated with LOS in the ED for patients in the highest triage level. These findings suggest that a centralized early sepsis alert system has the potential to improve patient outcomes.

The Effect of Lockdown on the Number of Trauma Cases and the Pattern of Injury in a Trauma Centre in Dubai During the Month of Lockdown and Comparing it to the Pre-COVID Time

Background: Due to the COVID-19 pandemic, full time lockdown was applied in many countries around the world. Published literature shows that the risk of suicide and assaults has increased but the risk of motor vehicle accidents has reduced. In this research, we want to study the impact of lockdown during the COVID-19 pandemic on the trauma cases who presented to the trauma cen-ter. Method: This retrospective cross-sectional study retrieved all the trauma cases who presented to the Emergency department in Rashid hospital during April 2019 and April 2020 from the patients&amp;apos; electronic records system. We included all the trauma cases who fell in the Canadian Triage and Acuity Scale (CTAS) of T1-T3 only. Results: Total of 3,268 trauma cases were studied. The number of cases in April 2019 was double the cases in 2020. However, the pattern of injuries was variable in the two years. There were high-er rates of motor vehicle accidents in non-lockdown month than the lockdown month (10.5% and 6.5%, respectively) (p-value

Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels.

Introduction Certain patient groups perceive specific barriers to accessing primary care, resulting in increased emergency department (ED) use for non-emergency conditions. There is evidence coming from other countries that homeless people are treated differently in accessing emergency services.Examination of ED wait time by demographic characteristics provides pertinent information to identify subgroups that are more subject to the consequences or causes of access block and delayed treatment. Methods We analyzed five years of Emergency Department Information System (EDIS) visit records of the largest tertiary care center in Atlantic Canada. The wait time from triage to seeing a physician was the outcome, housing status was the main exposure, and age and gender were the predictors. Quantile regressions were carried out to identify the influence of homeless visits in meeting the Canadian Association of Emergency Physicians (CAEP) wait time benchmarks for each Canadian Triage and Acuity Scale (CTAS) level. The classification and regression tree method was used to quantify and classify the demographic subgroups contributing to wait time disparities across CTAS levels. Results Homeless visit medianwait times that exceeded the three-hour CAEP benchmark were significantly longer for urgent (by 40 minutes, CI: 25-55), semi-urgent (by 31 minutes, CI: 17-45), and non-urgent (by 57 minutes, CI: 25-89) than acuity level-matched domiciled visitwait times. At the 50th percentile, one-hourbenchmark homeless triaged as semi-urgent waited (median=20 minutes, CI: 12-28) longer, and no other triage-level differences were found at this benchmark. Homeless emergent-level visits that exceeded the three-hour benchmark were 28 minutes, on average, shorter than domiciled patients of the same acuity level. Homeless females above 40 stayed the longest for non-urgent care (mean=173 minutes), 82 minutes longer (p=0.0001) than age-gender-acuity level-matched domiciled patients. Homelessness was the most prominent ED wait time classifier for non-urgent, ED visits.Overall, homeless patients triaged as CTAS-5 waited 30 minutes longer (p=0.0001) than domiciled patients triaged as CTAS-5.Homeless male 16-20-year-olds waited the shortest time of 72 minutes. Conclusion Homelessness-related wait time disparities exist in the low acuity non-urgent-level ED visits more than in the other levels, supporting the theory that lack of primary care access is a driver of ED use in this group. Our acuity level analysis supports that homeless people of a certain age (older) and gender groups (female) wait longer than their age-gender-matched domiciled patients to be seen by a physician in low acuity level presentations. Given the pattern of the homeless being seen earlier or statistically similar in emergent-level visits compared to matched domiciled patients and that 16-20-year-old homeless males were seen on average within 72 minutes (the shortest mean wait time reported for the triage level CTAS-5), we decline the notion of discrimination at the study site ED. If homeless patients' non-urgent needs were met elsewhere, pressure on the ED to meet benchmarks might be reduced.

Role of Venous Blood Gase (VBG) Analysis in Patient Triage in the Adult Emergency Department

Background: In emergency and critical care settings, can a venous blood gas analysis improve clinical decision-making and patient outcomes? Methods: This is a cross-sectional study, conducted between January and June 2022 at a tertiary hospital in Saudi Arabia. Results: A total of 100 patients were included, using a convenience sample technique. Their mean age was 54 years, and theirmain chief complaints were shortness of breath (30%), abdominal pain (15%), and altered level of consciousness (14%). The venous blood gas (VBG) result was abnormal in 86 patients, and predicted the need for early intervention in 69 patients (69.7%). A significant association was found between patients requiring early intervention and those with an abnormal VBG (p=0.0005). Furthermore, the VBG results changed the Canadian Triage and Acuity Scale (CTAS) level in 32 patients (33.68%). A logistic regression analysis revealed that pre-testing factors such as age, gender, comorbidities, and chief complaints were not predictors of VBG results, the need for early intervention, or altered CTAS level. Conclusion: Our study concludes that VBG analysis can play an important role in patient triage in the emergency department (ED), allowing for earlier intervention and potentially improving outcomes.

Development of a machine learning-based acuity score prediction model for virtual care settings

ObjectiveHealthcare is increasingly digitized, yet remote and automated machine learning (ML) triage prediction systems for virtual urgent care use remain limited. The Canadian Triage and Acuity Scale (CTAS) is the gold standard triage tool for in-person care in Canada. The current work describes the development of a ML-based acuity score modelled after the CTAS system.MethodsThe ML-based acuity score model was developed using 2,460,109 de-identified patient-level encounter records from three large healthcare organizations (Ontario, Canada). Data included presenting complaint, clinical modifiers, age, sex, and self-reported pain. 2,041,987 records were high acuity (CTAS 1–3) and 416,870 records were low acuity (CTAS 4–5). Five models were trained: decision tree, k-nearest neighbors, random forest, gradient boosting regressor, and neural net. The outcome variable of interest was the acuity score predicted by the ML system compared to the CTAS score assigned by the triage nurse.ResultsGradient boosting regressor demonstrated the greatest prediction accuracy. This final model was tuned toward up triaging to minimize patient risk if adopted into the clinical context. The algorithm predicted the same score in 47.4% of cases, and the same or more acute score in 95.0% of cases.ConclusionsThe ML algorithm shows reasonable predictive accuracy and high predictive safety and was developed using the largest dataset of its kind to date. Future work will involve conducting a pilot study to validate and prospectively assess reliability of the ML algorithm to assign acuity scores remotely.

Knowledge, Awareness, and Understanding of Pediatric Triage Among Nursing Officers in India: A Multicenter Study.

Triage is crucial in patient screening within emergency departments (EDs) worldwide. It is one of the essential and standard medical practices in many developed countries. However, in India, there is a need for improvement in triage utilization, as it is predominantly performed by resident doctors or medical officers, leading to an uneven distribution of clinical skills among healthcare providers (HCPs). A comprehensive analysis incorporating literature review and data collection revealed that while mandatory screening is conducted in most Indian EDs, the formal implementation of standardized triage protocols remains limited. Like in developed countries, registered nurses or nursing officers (NOs) can be effectively trained and directed to play the role of dedicated triage personnel in EDs of most of the healthcare facilities in India. This study aimed to examine the current state of triage utilization and its impact on the distribution of responsibilities among HCPs in Indian EDs. Through this online survey, the investigatorsassessed the knowledge and practical understanding of clinical triaging among NOs, working at various hospitals nationwide. The participants included 5,029 NOs working in various parts of India, predominantly nursing graduates (82.52%), the majority being employed in government healthcare settings (84.01%)and most having over five years of cumulative working experience in the ED (70.77%). Nurses showed inadequate knowledge and awareness about the Pediatric Assessment Triangle (PAT) used for quick initial evaluation (62.18%amongall participants). Concerning the complete triage process applicable, especially in pediatric ED settings, they had even less satisfactory knowledge and understanding, e.g., identifying primary (28.27%) and secondary (22.69%) survey components via focused history and examination, properly using temperature assessment (23.32%) and instant blood glucose level assessment (22.95%) in triage, and knowing various types of internationally accepted triage systems for ED-based health facilities such as the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS) (15.87%). ANOVA and post hoc analysis revealed that the intergroup performance of the study participants with maximum correct responses to the knowledge-determining specified subset of the questionnaire depicts the significantly higher role of graduate nursing degree over diploma such as General Nursing and Midwifery (GNM)/Auxiliary Nursing and Midwifery (ANM) qualification, working in government hospital versus private setup, and ED working experience of >5 years over that of <5 years. Of the participants in the study, 50% were not evaluated for cognitive or psychomotor domains during their assessment examinations. The research illuminated a significant disparity in knowledge and proficiency levels among Indian nurses concerning pediatric triage, especially with the ability to effectively apply the PAT for initial patient evaluations, discern components of primary and secondary surveys, and comprehend various triage systems. This study underscores the importance of comprehensive reform in the Indian healthcare system and teaching curriculum by emphasizing clinical triage training and interprofessional collaboration, and establishing guidelines and regulations to ensure consistent and standardized triage practices across all EDs.

The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department.

Despite the pivotality of emergency medical services (EMS) in prehospital care for patient stabilization, prehospital intravenous(IV) access, a standard practice, remains an ambiguity in Saudi Arabia in terms of its prevalence of placement, justification, and utilization. In this study, we aim to estimate the prevalence and utilization rate of prehospital IV access placement in patients transported to King Khalid University Hospital (KKUH)Emergency Medicine Department in Riyadh by EMS and determine the relationship between the prevalence and utilization rate of prehospital IV access in Canadian Triage and Acuity Scale (CTAS) levels 1 and 2in trauma and non-trauma patients. This observational cross-sectional study was conducted over six months. A total of 181 cases of CTASlevels 1 and 2 adult patients were included. Data were collected by trained nurses using convenient sampling through an author-developed questionnaire. The prevalence of prehospital IV line placement was 28.7%, with a utilization rate of 50%, and was notably higher among CTAS level 1 cases (69.2%). Additionally, trauma cases had a higher prevalence of prehospital IV access (53.5%) compared to medical cases (odds ratio (OR): 4.73, 95% confidence interval (CI): 4.73, 4.73, p<0.05). Among patients with prehospital IV lines, the majority (92.3%) were patent and functional. Upon arrival, 73.1% of patients had their prehospital IV line replaced, with hospital protocol being the most common reason for the replacement (73.7%). A minority of the patients had prehospital vascular access, and of those, half remained unused. Trauma cases and CTAS level 1 patients had a higher prevalence and utilization of prehospital IV access. Furthermore, trauma cases were more associated with prehospital IV access establishment and utilization.

Effect of the COVID-19 pandemic on emergency department utilization of computed tomography scans of appendicitis and diverticulitis

PurposeInvestigating the effect of the COVID-19 lockdown on adult patient visits, computed tomography (CT) abdominal scans, and presentations of appendicitis and diverticulitis, to emergency departments (ED) in St. John’s NL.MethodsA retrospective quantitative analysis was applied, using ED visits and Canadian Triage and Acuity Scale (CTAS) scores. mPower (Nuance Communications, UK) identified CT abdominal scan reports, which were categorized into (1) normal/other, (2) appendicitis, or (3) diverticulitis. Time intervals included pre-lockdown (January–February), lockdown (March–June), and post-lockdown (July–August). Data from 2018 to 2019 (January–August) were used to generate expected patient volumes for 2020, and pre- and post-lockdown were included to control for other variables outside the lockdown.ResultsChi-squared goodness of fit tested for deviations from predicted means for 2018–2019. Compared to expectations, daily ED visits from January to August 2020 showed a significant (p < 0.001) decrease in patient volumes independent of gender, age, and CTAS scores. During and post-lockdown, CT abdominal scans did not drop in proportion to patient volume. Appendicitis presentations remained indifferent to lockdown, while diverticulitis presentations appeared to wane, with no difference in combined complicated cases in comparison to what was expected.ConclusionDuring lockdown, significantly fewer patients presented to the ED. The proportion of ordered CT abdominal scans increased significantly per person seen, without change in CTAS scores. Considering combined pathology cases increased during the lockdown, ED physicians were warranted in increasing abdominal imaging as patients did not avoid the ED. This may have resulted from a change in clinical practice where the uncertainty of COVID-19 increased CT scan usage.

Analysis of Emergency Department Use by Non-Urgent Patients and Their Visit Characteristics at an Academic Center

We studied the extent and reasons for non-urgent emergency department (ED) visits in a single university hospital, their predictors, and patient outcomes to propose solutions suitable for Middle Eastern healthcare systems. We conducted a retrospective review of electronic medical records, including all non- and less-urgent ED visits with complete triage records (levels 4 and 5 triage based on the Canadian Triage and Acuity Scale (CTAS) over one year. The data on patient demographics, visit characteristics, and patient disposition were analyzed using SPSS software. The study was conducted in the ED at King Abdullah Bin Abdul-Aziz University Hospital (KAAUH), a Saudi university hospital located within the campus of Princess Nourah Bint Abdulrahman University. A chart review was carried out for 18,880 patients with CTAS 4 or 5 visiting the KAAUH ED between July 2020 and July 2021. Additionally, a total of "11,857" patients with missing triage acuity or CTAS levels 1, 2, or 3 were excluded from the study. The majority (61.4%) of the 30,737 ED visits were less-urgent or non-urgent. The most common reasons for non-urgent visits were routine examination/investigation (40.9%), medication refilling (14.6%), and upper respiratory tract infection/symptoms (9.9%). Most visits (73.4%) were during weekdays and resulted in the prescription of medication (94.2%), laboratory tests (62.8%), sick leaves (4.7%), radiology examinations (3.6%), and a visit to primary healthcare clinics (family medicine) within a week of the emergency visit (3.6%). Less- and non-urgent ED visits often did not need any further follow-ups or admission and represented a burden better managed by a primary healthcare center. Policymakers should mitigate unnecessary ED visits through public awareness, establish clear regulations for ED visits, improve the quality of care in primary healthcare centers, facilitate booking for outpatient department appointments, and regulate the systems of payment coverage/insurance and referral by other organizations.

A time and motion study in pediatric ER of the Secondary Hospital in Al Jouf Region, Saudi Arabia.

In the hospital setting, long waiting times and the lengthy formal process have increased the inefficiency and mismanagement resulting in the missing chance of saving the patients' life. Our aim was to assess the time wastage of every patient coming from reception to the actual emergency unit, to analyze the factor associated with the time lapse that occurs during every visit, and to see the effect of training on the services provided in the Pediatric emergency room. An intervention study was carried out in the following secondary care hospital in the Al Jouf region, Saudi Arabia: Esawiyah Hospital, Haditha Hospital, King Faisal Hospital, and Gurayat General Hospital among 400 study participants for 12 months. The study was carried out in 2 phases: pre-training, a period of training for hospital staff, and post-training data collection. Templates were generated on an MS Excel sheet and analysis of data was done using SPSS software. Percentages and proportions were calculated for descriptive statistics. Male and female patients were in the ratio of nearly 1:1. Training has significantly reduced the time to doctor consultation (U = 188, p < 0.001), and the time difference pre- and post-training from triage to consultation in a pediatric emergency is not significant (U = 16,769, p = 0.01). There is a strongly significant association (p < 0.001) between Canadian Triage and Acuity Scale (CTAS) implementation in triage. The practice of giving intravenous (IV) antibiotics in the emergency room has reduced significantly (p < 0.001) post-training. Training has a significant impact on the services provided in the pediatric emergency room.

Knowledge and Skills in Triage Assessment among Nurses in Emergency Department Hospital Saudi Arabia

Introduction: Triage is the nursing process and the first step for patients who came to or were brought to the Emergency Department (ED). As hospitals have more patients, the ED becomes overcrowded with non-emergency patients. An inaccurate triage decision not only delays patient treatment but also incurs unnecessary expenses for the facility. Patients in the waiting area should be reassessed to determine their conditions. Treatment for patients on a first-come, first-served basis without regard to the triage acuity level of their illnesses for severity, may result in delays for critically ill patients. The rationale of triage in the ED is to prioritize incoming patients and identify those who need to be seen first. Methods: Descriptive study using cross-sectional questionnaires for non-random sampling. Quantitative approaches were chosen as the study type. Questionnaires were completed by 41 of the selected sample size. The aim of the study is to determine the level of knowledge and skills in triage assessment among nurses in Emergency Department Hospitals in Saudi Arabia. Results: Response rates of 100% were obtained from the study. 19 (46.3%) of the participants were aged between 31-40 years old. Most of the respondents have Bachelor’s in nursing which are 38 (92.7%). Respondents with experience in ED of about 11-20 years are 18 (43.9%) of the total. 100% of respondents say that they are familiar with the Canadian Triage and Acuity Scale (CTAS) triage primary assessment. 100% will change the CTAS level when the patient deteriorates, and 100% agreed to give Paracetamol to the patient with a body temperature of more than 38 degrees. Seven skill level questions were completed with 100% correct answers. There is no significant relationship between triage knowledge and triage skill Conclusion: This finding indicates that there is a high level of knowledge and skill in triage assessment. Hence high knowledge and good skill should be maintained by continuing education, in-service, and training.

Pediatric emergency triage systems.

ABSTRACTObjective:The aim of this study was to perform a narrative review of the leading pediatric triage systems in emergency departments (EDs).Data source:Articles published between 1999 and 2019 were identified by searching the MEDLINE, EMBASE, and PubMed databases using the keywords “pediatric triage”, “pediatric assessment tools”, and “emergency department triage” with an emphasis on studies that evaluated the validation and reliability of triage systems.Data synthesis:A total of 105 articles on pediatric emergency triage systems in 12 countries were evaluated. Triage systems were divided into two groups: color-stratified triage systems and alert systems. The color-stratified triage systems included in this review were the Canadian Triage and Acuity Scale (CTAS), Manchester Triage System (MTS), Emergency Severity Index (ESI), and Australasian Triage Scale (ATS), and the alert systems included were the Paediatric Observation Priority Score (POPS), Pediatric Early Warning Score (PEWS), and Pediatric Approach Triangle (PAT). Evidence corroborates the validity and reliability of MTS, PaedCTAS, ESI version 4, PEWS, POPS, and PAT in pediatric emergency services.Conclusions:These are fundamental tools for risk classification of patients seeking treatment in EDs. Not all triage systems have been assessed for validity and reliability; nor are they well suited for all regions of the world. Employing triage systems in Brazil requires cultural adaptation and rigorous training of the local health staff, in addition to validation and reliability studies in our country, since the social and cultural context of this country differs from those where these tools were developed.

Does the definition of preventable emergency department visit matter? An empirical analysis using 20 million visits in Ontario and Alberta.

This study had two objectives: (1) to estimate the prevalence of preventable emergency department (ED) visits during the 2016-2020 time period among those living in 19 large urban centers in Alberta and Ontario, Canada, and (2) to assess if the definition of preventable ED visits matters in estimating the prevalence. A retrospective, population-based study of ED visits that were reported to the National Ambulatory Care Reporting System from April 1, 2016, to March 31, 2020, was conducted. Preventable ED visits were operationalized based on the following approaches: (1) Canadian Triage and Acuity Scale (CTAS), (2) ambulatory care-sensitive conditions (ACSC), (3) family practice-sensitive conditions (FPSC), and (4) sentinel nonurgent conditions (SNC). The overall proportion of ED visits that were preventable was estimated. We also estimated the adjusted relative risks of preventable ED visits by patients' sex and age, fiscal year, province of residence, and census metropolitan area (CMA) of residence. There were 20,171,319 ED visits made by 8,919,618 patients ages 1 to 74 who resided in one of the 19 CMAs in Alberta or Ontario. On average, there were 2.26 visits per patient over the period of 4 fiscal years; most patients made one (44.22%) or two ED visits (20.72%). The overall unadjusted prevalence of preventable ED visits varied by definition; 35.33% of ED visits were defined as preventable based on CTAS, 12.88% based on FPSC, 3.41% based on SNC, and 2.33% based on ACSC. There is a substantial level of variation in prevalence estimates across definitions of preventable ED visits, and care should be taken when interpreting these estimates as each has a different meaning and may lead to different conclusions. The conceptualization and measurement of preventable ED visits is complex and multifaceted and may not be adequately captured by a single definition.

Characteristics and predictors of high acuity pediatric patients presenting to a regional community healthcare system who require transfer to a tertiary pediatric center.

Purpose: To identify the characteristics at triage of high acuity pediatric patients who presented to community emergency departments and determine predictors for those who require transfer to a tertiary care pediatric center. Patients and methods: We conducted a retrospective study of all pediatric Canadian Triage and Acuity Scale (CTAS) I patients presenting to five semirural hospital sites from January to December 2018. Univariate tests were used to identify significant predictors for transfer based on age, gender, Pediatric Early Warning Score (PEWS) score and presenting complaint. A multivariate model was developed based on backward selection from the significant factors from the univariate analysis to identify predictors for transfer. Results: There were 1,137 subjects with an average age of 5.08 years (SD: 5.03) of whom, 559 (49.2%) were males. Sixty patients (5.3%) were transferred to a tertiary care center (60.9% &lt;4 years). A PEWS score ≥3 (OR 3.005, 95% CI 1.623–5,563), presenting with trauma (OR 6.617, 95% CI 2.820–15-531), mental health issues (OR 5.131, 95% CI 1.444–18.232), or neurological issue (OR 3.057, 95% CI 1.355–6.896) were associated with transfer. Patients with fever (OR 0.113, 95% CI 0.031–0.407) and respiratory symptoms (OR 0.345, 95% CI 0.142–0.840) were less likely to be transferred. Conclusion: Predictors of transfer from a community hospital to a pediatric tertiary care center were a PEWS score ≥3, trauma patients, those presenting with mental health issues, and patients with neurological symptoms. Early recognition can facilitate quicker transfer of these high acuity patients requiring tertiary care management.

The Association Between Abnormal Vital Signs and Mortality in the Emergency Department.

BackgroundThe emergency department (ED) receives patients from all over the world every day. Hence, using various triage scales to detect sick patients and the need for early admission are essential. Triage is a process used in the ED to prioritize patients requiring the most urgent care over those with minor injuries based on medical urgency and medical needs. These decisions may be based on patients’ chief complaints at the time of their ED visit and their vital signs. Vital signs, including blood pressure (BP), respiratory rate (RR), heart rate (HR), and body temperature, are necessary tools that are traditionally used in the ED during procedures such as triage and recognizing high-risk hospital inpatients. This study aimed to determine the relationship between abnormal vital signs and mortality in the ED.Method and MaterialThis retrospective record review study was performed at the ED of King Abdulaziz University Hospital (KAUH). Altogether, 641 patients fulfilled our inclusion criteria. Data including patients’ demographics, vital signs, in-hospital mortality, triage level, and precipitating factors were collected.ResultsThe mean age of the patients was 45.66 ± 18.43 years (69.3% females), and the majority of them had Canadian Triage and Acuity Scale (CTAS) level 3 (71.1%). The total number of in-hospital mortalities was 32 (5%). Lower systolic blood pressure (SBP) and diastolic blood pressure (DBP), high respiratory rates, and low oxygen saturation (O2SAT) were significantly associated with high mortality rates.ConclusionAbnormal vital signs play a major role in determining patient prognosis and outcomes. Triage score systems should be adjusted and carefully studied in each center according to its population.

Pediatric triage variations among nurses, pediatric and emergency residents using the Canadian triage and acuity scale

BackgroundEmergency care continues to be a challenge, since patients’ arrival is unscheduled and could occur at the same time which may fill the Emergency Department with non-urgent patients. Triaging is an integral part of every busy ED. The Canadian Triage and Acuity Scale (CTAS) is considered an accurate tool to be used outside Canada. This study aims to identify the chosen triage level and compare the variation between registered nurses, pediatric and adult emergency residents by using CTAS cases.MethodThis study was conducted at King Abdulaziz Medical City,Saudi Arabia. A cross-sectional self-administered questionnaire was used, and which contains 15 case scenarios with different triage levels. All cases were adopted from a Canadian triage course after receiving permission. Each case provides the patient’s symptoms, clinical signs and mode of arrival to the ED. The participants were instructed to assign a triage level using the following scale. A non-random sampling technique was used for this study. The rates of agreement between residents were calculated using kappa statistics (weighted-kappa) (95%CI).ResultA total of 151 participants completed the study questionnaire which include 15 case scenarios. 73 were nurses and 78 were residents. The results showed 51.3, 56.6, and 59.9% mis-triaged the cases among the nurses, emergency residents, and pediatric residents respectively. Triage scores were compared using the Kruskal Wallis test and were statistically significant with a p value of 0.006. The mean ranks for nurses, emergency residents and pediatric residents were 86.41, 73.6 and 59.96, respectively. The Kruskal Wallis Post-Hoc test was performed to see which groups were statistically significant, and it was found that there was a significant difference between nurses and pediatrics residents (P value = 0.005). Moreover, there were no significant differences found between nurses and ER residents (P value> 0.05).ConclusionThe triaging system was found to be a very important tool to prioritize patients based on their complaints. The results showed that nurses had the greatest experience in implementing patients on the right triage level. On the other hand, ER and pediatric residents need to develop more knowledge about CTAS and become exposed more to the triaging system during their training.

IMPACT OF EMERGENCY DEPARTMENT TRIAGE ON TIMELY ECG ACQUISITION

<h3>BACKGROUND</h3> Percutaneous coronary intervention (PCI) is the standard of care reperfusion therapy in the management of STEMI. Timeliness is critical to the effectiveness of PCI and shorter times to reperfusion are associated with decreased morbidity and mortality. To expedite reperfusion, guidelines recommend STEMI patients should receive an ECG within 10 minutes from initial presentation, represented as first medical contact to electrocardiogram (FMC-to-ECG) time. Various factors have been suggested to impact FMC-to-ECG time including triaged acuity, measured by the Canadian Triage and Acuity Scale (CTAS). Designations of CTAS 1 and 2 indicate higher triage levels demanding priority attention over CTAS 3, 4 or 5. <h3>METHODS AND RESULTS</h3> This is a retrospective observational study of three emergency departments (ED) within a non-PCI capable health system. Walk-in patients with an ECG suggesting STEMI from 2017-2019 were identified (n=276). Charts were reviewed and only true walk-in patients with a final diagnosis of STEMI and data necessary to calculate FMC-to-ECG times were included (n=165). Furthermore, all patients with a chief complaint of chest pain presenting to the three emergency departments during 2017-2019 were also identified to establish a baseline CTAS triage rate. The primary objective of this study is to investigate if ED triage acuity is associated with timely ECG in walk-in STEMI patients. 95% of STEMI patients were triaged as CTAS 1 or 2 compared to 79.7% of all patients presenting with a complaint of chest pain. 55% of STEMI patients with a CTAS 1 or 2 designation received a timely ECG compared to 50% of STEMI patients with a CTAS 3, 4 or 5 designation. Statistical analysis of proportions between groups was performed by using Chi squared tests of independence or Fisher's exact test where appropriate. <h3>CONCLUSION</h3> Walk-in STEMI patients were significantly more likely to receive a higher priority CTAS designation of 1 or 2 compared with any patient presenting with chest pain. Despite the appropriate triage designation, only 55% of CTAS 1 or 2 patients received timely ECGs and they were not more likely to receive a timely ECG over lower priority CTAS designations. Taken together, these findings suggest the presence of a system-related delay in FMC-to-ECG time. Interventions designed to improve the ability of patients to receive ECGs and activate STEMI management pathways at the level of ED triage may be helpful in identifying STEMI patients earlier, thereby expediting their reperfusion time.