Triage System Research Articles

Triage Performance Across Large Language Models, ChatGPT, and Untrained Doctors in Emergency Medicine: Comparative Study.

Large language models (LLMs) have demonstrated impressive performances in various medical domains, prompting an exploration of their potential utility within the high-demand setting of emergency department (ED) triage. This study evaluated the triage proficiency of different LLMs and ChatGPT, an LLM-based chatbot, compared to professionally trained ED staff and untrained personnel. We further explored whether LLM responses could guide untrained staff in effective triage. This study aimed to assess the efficacy of LLMs and the associated product ChatGPT in ED triage compared to personnel of varying training status and to investigate if the models' responses can enhance the triage proficiency of untrained personnel. A total of 124 anonymized case vignettes were triaged by untrained doctors; different versions of currently available LLMs; ChatGPT; and professionally trained raters, who subsequently agreed on a consensus set according to the Manchester Triage System (MTS). The prototypical vignettes were adapted from cases at a tertiary ED in Germany. The main outcome was the level of agreement between raters' MTS level assignments, measured via quadratic-weighted Cohen κ. The extent of over- and undertriage was also determined. Notably, instances of ChatGPT were prompted using zero-shot approaches without extensive background information on the MTS. The tested LLMs included raw GPT-4, Llama 3 70B, Gemini 1.5, and Mixtral 8x7b. GPT-4-based ChatGPT and untrained doctors showed substantial agreement with the consensus triage of professional raters (κ=mean 0.67, SD 0.037 and κ=mean 0.68, SD 0.056, respectively), significantly exceeding the performance of GPT-3.5-based ChatGPT (κ=mean 0.54, SD 0.024; P<.001). When untrained doctors used this LLM for second-opinion triage, there was a slight but statistically insignificant performance increase (κ=mean 0.70, SD 0.047; P=.97). Other tested LLMs performed similar to or worse than GPT-4-based ChatGPT or showed odd triaging behavior with the used parameters. LLMs and ChatGPT models tended toward overtriage, whereas untrained doctors undertriaged. While LLMs and the LLM-based product ChatGPT do not yet match professionally trained raters, their best models' triage proficiency equals that of untrained ED doctors. In its current form, LLMs or ChatGPT thus did not demonstrate gold-standard performance in ED triage and, in the setting of this study, failed to significantly improve untrained doctors' triage when used as decision support. Notable performance enhancements in newer LLM versions over older ones hint at future improvements with further technological development and specific training.

Development and implementation of a rehabilitation triage algorithm for disasters in the subacute phase: an experience from the 2024 Noto peninsula earthquake

Early rehabilitation during disasters such as earthquakes is an important but often undervalued responsibility of medical teams. Both the development of simple tools for assessing the life functioning of evacuees and the standardization of intervention methods are urgent issues in disaster rehabilitation. The Japanese Rehabilitation Assistance Team (JRAT), an officially recognized organization consisting of 10 suborganisations, was established after gaining important experience with disaster rehabilitation in the aftermath of the Great East Japan Earthquake. We, the Hiroshima JRAT, were dispatched to the Monzen area of Wajima City to support disaster recovery after the 2024 Noto Peninsula Earthquake. Since disaster rehabilitation assistance was not well established in the Monzen area of Wajima City, the medical team consulted JRAT for guidance on triaging evacuees based on their life functioning. We developed a rehabilitation triage algorithm that classifies evacuees into four triage tags based on their ability to perform three simple movements: sitting up, standing up from the floor, and one-leg standing. In our triage algorithm, an inability to sit up is classified as a red tag (difficulty living in a shelter without assistance), an inability to stand up from the floor is classified as a yellow tag (individual intervention: introduction of beds and handrails), one-leg standing for &amp;lt; 2 s is classified as a green tag (group intervention: installation of toilets and bath rails and use of walkers to prevent falls), and standing on one leg for more than 2 s is classified as a white tag (independent in ADLs). We worked with medical teams to triage 922 evacuees in 27 evacuation centers, resulting in the extraction of four red and eight yellow evacuees in 1 day. Our rehabilitation triage system has the potential to be a simple assessment tool for classifying the life functioning of disaster victims and linking them to appropriate supports.

Training of interns in the system of medical triage of patients on the basis of the Simulation Center of the Kazakh National Medical University

Providing emergency care to patients is a basic skill for doctors of any specialty. Emergency department overcrowding is a pressing public health problem that affects countries around the world. Medical Triage or triage is the process of prioritizing medical care for patients based on the severity of their condition.

Predictability of the emergency department triage system during the COVID-19 pandemic.

Emergency department (ED) triage systems are used to classify the severity and urgency of emergency patients, and Korean medical institutions use the Korean Triage and Acuity Scale (KTAS). During the COVID-19 pandemic, appropriate treatment for emergency patients was delayed due to various circumstances, such as overcrowding of EDs, lack of medical workforce resources, and increased workload on medical staff. The purpose of this study was to evaluate the accuracy of the KTAS in predicting the urgency of emergency patients during the COVID-19 pandemic. This study retrospectively reviewed patients who were treated in the ED during the pandemic period from January 2020 to June 2021. Patients were divided into COVID-19-screening negative (SN) and COVID-19-screening positive (SP) groups. We compared the predictability of the KTAS for urgent patients between the two groups. From a total of 107,480 patients, 62,776 patients (58.4%) were included in the SN group and 44,704 (41.6%) were included in the SP group. The odds ratios for severity variables at each KTAS level revealed a more evident discriminatory power of the KTAS for severity variables in the SN group (P<0.001). The predictability of the KTAS for severity variables was higher in the SN group than in the SP group (area under the curve, P<0.001). During the pandemic, the KTAS had low accuracy in predicting patients in critical condition in the ED. Therefore, in future pandemic periods, supplementation of the current ED triage system should be considered in order to accurately classify the severity of patients.

Accuracy of a mobile sensor-based system for the detection of chemotherapy toxicity in older adults with cancer.

1515 Background: Older adults receiving chemotherapy (CT) are at a high risk of toxicity (Tox) and of functional decline. Promptly acting upon CT Tox in older adults is difficult, particularly in developing countries where triage systems and personnel are limited. We previously showed that monitoring older patients using an accelerometer-equipped smartphone is feasible, and that a decline in the number of steps/day may represent a marker of Tox. We aimed to evaluate the diagnostic accuracy of an objective patient-centered measure of physical function (steps/day) for the remote detection of Tox in older adults receiving CT. Methods: We included consecutive patients aged ≥65 years starting first line CT for solid tumors at a single center in Mexico City. Patients underwent a geriatric assessment and were provided with an accelerometer-equipped smartphone. Daily steps were recorded for ≥7 days pre-CT initiation, and median number of pre-CT steps/day was calculated. Patients with ≤600 median pre-CT steps/day, and those using walking aids, were excluded (16% of recruited patients). Steps were monitored daily, compared with median pre-CT steps/day, and % decline was calculated. Patients were called daily, and Tox was assessed using PRO-CTCAE questionnaires. The % decline in steps/day from pre-CT was considered as the index test for Tox, while patient report was considered the reference standard. The association between % step decline and moderate/severe Tox was examined using generalized linear-mixed models. AUC was calculated and Youden’s index used to choose cutoff points for Tox detection. Results: 116 patients were included (96 development cohort, 20 validation cohort). Median age was 73y (range 65-91), 55% were female, and 65% had ≤high school education. The most common tumors were colon (21.5%), pancreas (17.5%), and gastric (12%). 28% of participants had never used a smartphone. The median number of pre-CT steps/day was 2979. Patients were followed for 6764 days, with Tox detected on 64.4% of days. Moderate/severe self-reported toxicity was detected on 1245 days (22.1%), while mild/no toxicity was detected on 4378 days (77.9%). AUC analysis for the development cohort demonstrated that a 32% decrease in steps/day from pre-CT median showed a sensitivity of 77.6% and a specificity of 67.3% for detecting moderate/severe Tox. Sensitivity and specificity of the cutoff in the validation cohort were 75.8% and 69.6%, respectively. Tox associated with a decline in steps/day included fatigue, pain, and nausea. Conclusions: A decline in the number of steps/day measured using an accelerometer-equipped smartphone was useful for the remote detection of moderate/severe Tox in older adults with cancer receiving CT, with a high sensitivity and specificity. This patient-centric measure could be used in clinical practice and research to detect and act promptly on Tox and, potentially, improve outcomes.

Patients' Perceptions Resulting from the Contact with Emergency Departments Using the Manchester Triage System Protocol

Patients' Perceptions Resulting from the Contact with Emergency Departments Using the Manchester Triage System Protocol

Impact of the COVID-19 Pandemic on Nurses and an Ecological System Theory-Based Strategy for Reducing This Impact in the Future

The COVID-19 pandemic led to significant burnout among nurses, resulting in a shortage of nursing staff. Issues related to nursing work have received significant attention recently, and only healthy nurses are capable of providing good quality patient care. The authors employed Bronfenbrenner's Ecological System Theory to analyze the impact of the COVID-19 pandemic on nurses and proposed specific strategies and recommendations to enhance the nursing workplace. Under the Ecological System Theory, several factors, including inadequate preparedness, dangerous working environment, work-family conflicts, discrimination due to public panic, and health damage, contribute to nurse burnout. Whether during or after the COVID-19 pandemic, it is necessary to provide education programs to enhance the professional abilities of nurses, foster policies that promote a positive practice work environment, implement a triage system based on the severity of patients,elevate theimage of the nursing profession, monitor the health of nurses, and advocate for transformational leadership. The nursing workplace should help nurses gain greater confidence and improve their ability to handle various workplace challenges. In the future, medical institutions should provide a better work environment for nurses and expect the public to pay more attention to the development of the nursing profession.

Drinking from the Holy Grail-Does a Perfect Triage System Exist? And Where to Look for It?

The Emergency Department (ED) is a facility meant to treat patients in need of medical assistance. The choice of triage system hugely impactsed the organization of any given ED and it is important to analyze them for their effectiveness. The goal of this review is to briefly describe selected triage systems in an attempt to find the perfect one. Papers published in PubMed from 1990 to 2022 were reviewed. The following terms were used for comparison: "ED" and "triage system". The papers contained data on the design and function of the triage system, its validation, and its performance. After studies comparing the distinct means of patient selection were reviewed, they were meant to be classified as either flawed or non-ideal. The validity of all the comparable segregation systems was similar. A possible solution would be to search for a new, measurable parameter for a more accurate risk estimation, which could be a game changer in terms of triage assessment. The dynamic development of artificial intelligence (AI) technologies has recently been observed. The authors of this study believe that the future segregation system should be a combination of the experience and intuition of trained healthcare professionals and modern technology (artificial intelligence).

Fundamentals of Emergency Initial Assessment: A Comprehensive Review

Emergency initial assessment is a critical process in emergency medicine, ensuring that patients receive timely and appropriate care based on the severity of their condition. This comprehensive review explores the fundamental principles of emergency initial assessments, focusing on the primary and secondary survey methods, including the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure). The review also discusses the essential tools and techniques used during assessments, such as vital signs monitoring, diagnostic tools, and triage systems. Best practices and guidelines from leading medical organizations are highlighted, alongside evidence-based approaches that improve patient outcomes. Additionally, the review addresses common challenges faced during emergency assessments, such as time constraints, resource limitations, and communication barriers. By emphasizing the importance of continuous training, technological advancements, and quality improvement initiatives, this review aims to provide healthcare professionals with a solid foundation for performing effective emergency initial assessments. The article concludes by identifying areas for future research and potential innovations that could further enhance emergency care practices.

THE START SORTING SYSTEM AND THE NURSE’S PARTICIPATION IN ITS IMPLEMENTATION

Introduction. This article highlights the problem of organizing the sorting of patients during mass admission to medical institutions and providing emergency medical care. The role of the nurse in conducting triage and providing emergency care at the early hospital stage is within the framework of limited resources. The urgency of working out the response protocol in the event of an emergency. The aim of the study – to determine the role of the nurse in the triage and provision of emergency care at the early hospital stage within the framework of a limited resource. To establish the relevance of the use of the START medical triage system in the practical activities of a nurse. The relevance of working out the response protocol in the event of an emergency among nurses. The main part. The medical triage system START (Simple Triage and Rapid Treatment) is an effective tool for organizing and accelerating the process of correct routing of patients in mass cases and crises when resources are limited and medical needs are high. Medical triage criteria also include signs of primary medical examination. As their professional responsibilities expand, nurses can use the ABCD algorithm to assess the patient’s condition. Knowledge of the principles of this medical triage system, the ability to provide emergency medical care, evenly and effectively distribute resources, follow the instructions of the coordinating physician, describe medical documentation, and label the patient’s category have become the duties of nurses due to the increasing frequency of emergencies. Conclusions. The START (Simple Triage and Rapid Treatment) triage system is used for prompt and efficient selection of victims during emergencies. The role of the nurse in this process is extremely important. First of all, the nurse must have skills in the application of the START triage technique and an understanding of its basics. During triage, the nurse can quickly assess the condition of each victim, determine the category, and assign the appropriate color tag. Provision of emergency medical care in conditions of limited resources, coordination, and reporting for further organization of medical care are key elements in the formation of nursing competence during triage. Using the principles of medical triage can help optimize treatment and save more lives in emergencies.

#2768 Evaluation of vascular access via a TRIAGE system for hemodialysis: a tool to assess clinical risk in hemodialysis patients

Abstract Background and Aims The type and efficacy of vascular access (VA) in hemodialysis (HD) play pivotal roles in determining the quality of treatment and, eventually, the clinical outcome of patients. Low dialysis quality due to suboptimal vascular access functioning is a risk factor for increased cardiovascular mortality in HD. In a prior study involving 754 patients undergoing chronic HD, we demonstrated that a VA TRIAGE system effectively identified vascular accesses at a higher risk of complications both in patients with arteriovenous fistula (AVF) and in patients with central venous catheters (CVC). The TRIAGE categorization is generated monthly through a scoring system recording several parameters of each session, like blood flow, VA pressure, end HD circuit clots, external VA examination, and KT/V. Based on threshold values, VA performance is classified as Green (G), Yellow (Y), or Red). In this study, we aimed to assess whether the TRIAGE system, by identifying poorly functioning VA, could also identify patients at a higher risk of cardiovascular events. Method In this interventional prospective, blinded multicentre study, each centre utilized the VA TRIAGE electronic spreadsheet without knowledge of the generated triage. After six months of system implementation, a two-year follow-up (01/01/2020 - 01/12/2021) was conducted to record cardiovascular events (myocardial infarction, cerebrovascular accident, peripheral vasculopathy, unstable angina, atrial fibrillation, heart failure). External reviewers assessed the records, and a minimum of three months of VA follow-up was necessary for patient enrolment. Results From 18 HD centres, 757 patients were enrolled, with an average age of 64.5 ± 15.5 years; 27% were diabetics, undergoing HD for 24.4 ± 32.4 months; 369 (48.7%) had AVF, and 388 (51.3%) had a permanent CVC. Over 11.4±5.6 months of follow-up (range 3-23) and 108, 537 HD sessions recorded in the TRIAGE system, 100 cardiovascular-related events occurred during 16.3 ± 2.2 months of follow-up (range 3-23). The VA TRIAGE was: 60% Green, 35% Yellow, and 5% Red. The Green Triage group demonstrated a lower incidence of cardiovascular events independent of VA type (25% vs. 75%; P: 0.01) and a higher duration free from cardiovascular events (AVF Green vs. AVF Yellow-Red: log-rank test: 0.04). Conclusion Our VA TRIAGE system not only identifies poorly functioning vascular accesses but also effectively assesses the clinical risk in patients undergoing HD. This outcome, in our view, is linked to the diminished quality of dialysis resulting from lower VA function in the yellow and red Triage groups compared to the green Triage group. Integrating the VA TRIAGE system with additional clinical parameters enhances its capacity to assess the clinical risk of HD patients. This approach offers a more comprehensive evaluation, potentially improving the identification of patients at higher cardiovascular risk.

#2304 Innovative approaches to nephrology referrals: unlocking the potential of artificial intelligence

Abstract Background and Aims The widespread influence of Artificial Intelligence (AI) is evident across various sectors, including the medical field. Hospitals and healthcare systems are increasingly embracing its capabilities in order to improve clinic workflow, to save time and simplify procedures with some degree of complexity. One of those tasks is the referral process to Nephrology appointments by the Primary Care (PC) physicians. As they may face challenges in determining which patients meet the referral criteria, it would be of great help to create a tool that could assist the process. Our work aimed to understand if AI can be useful in the referral to Nephrology appointments in Portugal's National Healthcare System. Method A cross-sectional study was preformed using appointment requisitions made by PC Physicians to a single center Nephrology Department throughout 2023. An AI bot, named RefNef, was developed, incorporating referral criteria from our center, the Portuguese National Healthcare Authority, and the Kidney Disease Improving Global Outcome (KDIGO) guidelines. Stripping personal data, those requisitions were then submitted to the created bot, and the answers were analyzed. Statistical analyses, including T-student, ANOVA, and Chi-squared tests, were employed to compare different groups. Results A total of 408 referrals were analyzed (52% of them males), with a mean age of 74 ± 15 years old. Mean creatinine at referral was 1.87 ± 0.72 mg/dl, with a mean estimated Glomerular Filtration Rate using the Crockford-Gault equation of 33.23 ± 15.12 mL/min. 5.6% of them had hematuria and 15.2% had proteinuria at referral. These four criteria were lacking in the referral information in 19.37%, 56.86%, 92.9% and 61.5% of the requests, respectively, but their absence did not appear to affect the nephrologist's or the bot's rate of acceptance. 86.3% of the referrals were approved by the nephrologists, and the bot accepted 97.1% of them. The rate of acceptance was not related (χ2 (1, N = 208) = 5.038, p = 0.082). The time between the referral and the appointment differed from the PC's requirements, the bot's perspective and the actual time the appointment was scheduled. In 68.6% of the times, the bot provided the user with some useful information, as management tips or other details that should be investigated. There was a need to ask for further information to the bot in 3.18% of the cases. Conclusion While not yet poised to function as a triage system, as the information wasn't consistent with the decision of the nephrologist, the AI tool demonstrated utility in potentially aiding PC physicians in decision-making by providing useful information. Additionally, it exhibited user-friendliness, as it answers with all the needed details at the first question. Further refinement of the AI tool could enhance its alignment with nephrologist decisions, contributing to improved efficiency in the referral process. It is to be noted that the study also highlights the frequent omission of key criteria in Nephrology referrals, emphasizing the need for educational reinforcement in this aspect.

The Effects of Displaying the Time Targets of the Manchester Triage System to Emergency Department Personnel: Prospective Crossover Study.

The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets. This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED. We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS. The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred. Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.

Expectations of emergency patients regarding triage system knowledge upon arrival: an interpretive study

BackgroundOne of the most important aspects of healthcare knowledge is having a thorough understanding of the triage system which is used in emergency departments. This study aims to assess the level of awareness of Jordanian patients who visit the ED about the triage procedure.MethodsA descriptive, cross-sectional design was utilized in the emergency department at the biggest public hospital in Jordan. A convenience sample of a self-administrated questionnaire utilizing a Discounted Cash Flow Interview (DCF) survey was filled out.ResultsA total of 726 participants were recruited with a response rate of 90.8%. The mean age of the participants was M = 38.1 (SD = 12.9), and the age of the participants varied from 18 to 89 years. More than half of the participants were male (n = 383, 52.8%) and married (n = 425, 58.5%). A significant relationship between the overall perception of knowing what a teaching hospital is and patients’ educational level (X2 = 11.9, P < 0.003), current job (X2 = 25.2, P < 0.001), nationality (X2 = 7.20, P < 0.007), and family income (X2 = 15.9, P < 0.001).ConclusionMore investigation is required to determine the causes of the low knowledge of the triage system. The study suggests increasing staffing levels, giving nursing staff ongoing education and training, and integrating technology and automation to reduce the load of patient care.

Midwife-led obstetric triage to increase providers’ knowledge and improve timeliness of care: A pre and posttest design

BackgroundResearch in low- and middle-income countries has shown that maternal mortality is directly related to inadequate or absent obstetric (OB) triage systems. Standard triage systems and knowledge on triaging for obstetric emergencies are often absent or lacking in most healthcare systems in Liberia. ObjectiveThe objective of this research was to address the third delay defined as receiving adequate, quality care when a facility is reached by increasing knowledge through the establishment of a midwife-led, hospital-based OB triage system to stratify care based on risk and imminence of birth and to improve timely assessment at two district referral hospitals. MethodsA quasi-experimental study design using a pre/post survey was employed for a midwife-led OB triage training course. Using a train-the-trainer model, five midwives were trained as champions, who in turn trained an additional 62 providers. Test results were analyzed with the R statistical software using paired sample t-test and descriptive statistics. ResultsPretest results revealed a knowledge and practice gap among OB providers on key components of the standard triage package. However, post-test mean scores were significantly higher (M = 79.6, SD = 2.32) than pre-test mean scores (M = 59.0, SD = 2.30) for participants following a 2-day training (p = <0.001). DiscussionFollowing a structured OB triage training, participants showed significant improvement in post-test OB triage scores. ConclusionStandard OB triage protocols incorporated into the policies and procedures of obstetric wards have the potential to improve knowledge and practice, addressing the third delay and reducing preventable, obstetrics-related deaths.

Comparative analysis of ChatGPT, Gemini and emergency medicine specialist in ESI triage assessment

IntroductionThe term Artificial Intelligence (AI) was first coined in the 1960s and has made significant progress up to the present day. During this period, numerous AI applications have been developed. GPT-4 and Gemini are two of the best-known of these AI models. As a triage system The Emergency Severity Index (ESI) is currently one of the most commonly used for effective patient triage in the emergency department. The aim of this study is to evaluate the performance of GPT-4, Gemini, and emergency medicine specialists in ESI triage against each other; furthermore, it aims to contribute to the literature on the usability of these AI programs in emergency department triage. MethodsOur study was conducted between February 1, 2024, and February 29, 2024, among emergency medicine specialists in Turkey, as well as with GPT-4 and Gemini. Ten emergency medicine specialists were included in our study but as a limitation the emergency medicine specialists participating in the study do not frequently use the ESI triage model in daily practice. In the first phase of our study, 100 case examples related to adult or trauma patients were extracted from the sample and training cases found in the ESI Implementation Handbook. In the second phase of our study, the provided responses were categorized into three groups: correct triage, over-triage, and under-triage. In the third phase of our study, the questions were categorized according to the correct triage responses. ResultsIn the results of our study, a statistically significant difference was found between the three groups in terms of correct triage, over-triage, and under-triage (p < 0.001). GPT-4 was found to have the highest correct triage rate with an average of 70.60 (±3.74), while Gemini had the highest over-triage rate with an average of 35.2 (±2.93) (p < 0.001). The highest under-triage rate was observed in emergency medicine specialists (32.90 (±11.83)). In the ESI 1–2 class, Gemini had a correct triage rate of 87.77%, GPT-4 had 85.11%, and emergency medicine specialists had 49.33%. ConclusionIn conclusion, our study shows that both GPT-4 and Gemini can accurately triage critical and urgent patients in ESI 1&2 groups at a high rate. Furthermore, GPT-4 has been more successful in ESI triage for all patients. These results suggest that GPT-4 and Gemini could assist in accurate ESI triage of patients in emergency departments.

Rapid recognition and optimal management of hemophilia in the emergency department: A quality improvement project.

This study aimed to assess the effectiveness of a continuous quality improvement initiative at the University of Florida Health Physicians practice in reducing the time to administer factor replacement therapy (FRT) for hemophilia patients presenting with bleeding in the emergency department (ED). The study, a quasi-experimental, interventional design, was conducted between January 2020 and January 2023. The intervention, implemented in September 2021, involved training ED physicians, creating a specialized medication order set within the electronic health record (EHR), and a rapid triage system. The effectiveness was measured by comparing the time from ED arrival to factor administration before and after the intervention and benchmarking it against the National Bleeding Disorders Foundation's Medical and Scientific Advisory Council (MASAC)-recommended 1-hour timeline for factor administration. An interrupted time series (ITS) analysis with a generalized least squares model assessed the intervention's impact. A total of 43 ED visits (22 pre-intervention and 21 post-intervention) were recorded. Post-intervention, the average time from ED arrival to factor administration decreased from 5.63 to 3.15hours. There was no significant increase (27%vs. 29%) in the patients receiving factor within 1-hour of ED arrival. The ITS analysis predicted a 20-hour reduction in the average quarterly time to administer factor by the end of the study, an 84% decrease. The quality improvement program decreased the time to administer FRT for patients with hemophilia in the ED. However, the majority of patients did not achieve the 1-hour MASAC-recommended timeline for factor administration after ED arrival.

The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571

INTRODUCTION: Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia. METHODS: Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome. RESULTS: A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived. CONCLUSION: This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.

Quality improvement initiative: improving obstetric triaging practices in a rural maternal hospital in central India

Triaging of obstetric patients by emergency care providers is paramount. It helps provide appropriate and timely management to prevent further injury and complications. Standardised trauma acuity scales have limited applicability...

독일 연방헌법재판소 ‘Triage’ 결정(2021) 분석을 통해 본 장애인에 대한 차별 금지

During the COVID-19 pandemic, there were concerns that the German healthcare system's triage system for prioritizing care could be in crisis. ‘Triage’ is the process by which healthcare providers decide which patients are prioritized for treatment in situations where critical care medical resources cannot keep up with the demand. There are understandable concerns that people with disabilities, who are at higher risk of becoming critically ill with the COVID-19 virus, could be unfavorably treated by the way these decisions are made. The applicants argued that federal and state measures to prevent this were inadequate and insufficient in the face of the uncertainty of a possible shortage of medical resources. The legislator was therefore obliged to provide a legal basis for triage and to effectively regulate the classification to prevent discrimination. The Federal Constitutional Court found that the classification of patients during the COVID-19 pandemic exposed the applicants to the risk of being disadvantaged on account of their disability in relation to the allocation of intensive care resources. The Court also ordered the legislator to fulfill its duty to act promptly and to take preventive measures to prevent discrimination against persons with disabilities. This decision has been criticized of overlooking the argument that the consideration of the severity of the disease and the course of the disease in the triage process constitutes indirect discrimination against people with disabilities. The Federal Constitutional Court also left open the possibility of indirect discrimination when it did not declare unconstitutional the criteria for determining the likelihood of clinical success, i.e., the likelihood of surviving an acute illness. The ‘triage criterion’ may also violate the European Convention on Human Rights because the European Court of Human Rights has recognized a comprehensive concept of indirect discrimination within the Convention. In this case, the Triage Criteria could put people with disabilities at a disadvantage compared to people without disabilities in that the criteria of disability could still have a negative impact on the course and severity of COVID-19-19 infection, which constitutes indirect discrimination. The Federal Constitutional Court should endeavor to decide important and urgent issues promptly, but not to lose sight of the underlying approach to the problem and the various forms of discrimination that can result from it.