Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-19T06:01:11.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the Principality of Andorra: Can triage parameters serve as emergency department quality indicators?

Published online by Cambridge University Press:  21 May 2015

Josep Gómez Jiménez ,
Michael J. Murray ,
Robert Beveridge ,
Josep Pons Pons ,
Ester Albert Cortés ,
Joan B. Ferrando Garrigós  and
Marta Borràs Ferré
Josep Gómez Jiménez*
Affiliation:
Emergency Medicine Department, Hospital Nostra Senyora de Meritxell, Principality of Andorra
Michael J. Murray
Affiliation:
Emergency Department, Royal Victoria Hospital, Barrie, Ont., and McMaster University, Hamilton, Ont.
Robert Beveridge
Affiliation:
Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Josep Pons Pons
Affiliation:
Emergency Medicine Department, Hospital Nostra Senyora de Meritxell, Principality of Andorra
Ester Albert Cortés
Affiliation:
Emergency Medicine Department, Hospital Nostra Senyora de Meritxell, Principality of Andorra
Joan B. Ferrando Garrigós
Affiliation:
Emergency Medicine Department, Hospital Nostra Senyora de Meritxell, Principality of Andorra
Marta Borràs Ferré
Affiliation:
Informatics Department, Servei Andorrà d’Atenció Sanitària, Principality of Andorra
*
Emergency Department, Hospital Nostra Senyora de Meritxell, Avda. Fiter i Rossell 1-13, Escaldes-Engordany, Principality of Andorra; +376 346902, fax +376 868 100, jgomez@andorra.ad

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To assess the performance of the newly implemented Canadian Emergency Department Triage and Acuity Scale (CTAS) triage system in a redesigned 200-bed community hospital emergency department (ED) and to evaluate the predictive validity of CTAS in this setting.

Methods:

Triage system performance was analyzed on the basis of 4 quality indicators: time to triage; triage duration; proportion of patients who left without being seen by a physician; and waiting time to nurse and physician, stratified by triage level and reported as fractile response rates. The predictive validity of CTAS was evaluated by investigating the relationship between CTAS level, hospitalization index, ED length of stay (LOS) and diagnostic test utilization.

Results:

During the study period, 32 574 patients were triaged and 32 261 were eligible for study. Eighty-five percent were triaged within 10 minutes, and 98% had a triage duration of ≤5 minutes. Waiting times to nurse and physician were within CTAS time objectives in 96.3% and 92.3% of cases respectively. The left without being seen (LWBS) rate was 0.96%. Hospitalization rates were compatible with CTAS standards for adults in Levels I, II, III and V and for children in Level V. Median LOS and laboratory test utilization were highly correlated with CTAS Levels II to V (p < 0.01), and similar correlation between triage acuity and imaging utilization was noted in adult patients with non-traumatic non-musculoskeletal complaints (p < 0.01).

Conclusions:

The CTAS is adaptable to countries beyond Canada and its operating objectives are achievable. Time to triage and fractile response rates can be considered indicators of triage quality and ED performance. CTAS is a valid instrument for predicting admission rates, hospital LOS and diagnostic utilization.

Keywords

triageCanadian Emergency Department Triage and Acuity ScaleCTASfractile responseutilization
Type
EM Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 5 , September 2003 , pp. 315 - 322
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al. Canadian emergency department triage and acuity scale: implementation guidelines. Can J Emerg Med 1999;1 (suppl 3):S1–24.Google Scholar
2.Warren, D, Jarvis, A, Leblanc, L, and the National Triage Task Force members. Canadian paediatric triage and acuity scale: implementation guidelines for emergency departments. Can J Emerg Med 2001;3(4 suppl):S1–27.Google Scholar
3.Wuerz, RC, Milne, L, Eitel, DR, Travers, D, Gilboy, N. Reliability and validity of a new five-level emergency department triage instrument. Acad Emerg Med 2000;7:236–42.CrossRefGoogle ScholarPubMed
4.Felisart, J, Requena, J, Roqueta, F, Saura, RM, Suñol, R, Tomàs, S. Serveis d’Urgències: indicadors per mesura els criteris de qualitat de l’atenció sanitaria. Barcelona: Agencia d’Avaluació Tecnológica i Recerca Mediques. Servei Cátala de la Salut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya. Juny de 2001.Google Scholar
5.Baker, DW, Stevens, CD, Brook, RH. Patients who leave a public hospital emergency department without being seen by a physician. Causes and consequences. JAMA 1991;266:1085–90.CrossRefGoogle ScholarPubMed
6.Weissberg, MP, Heitner, M, Lowenstein, SR, Keefer, G. Patients who leave without being seen. Ann Emerg Med 1986;15:813–7.CrossRefGoogle ScholarPubMed
7.Dershewitz, RA, Paichel, W. Patients who leave a pediatric emergency department without treatment. Ann Emerg Med 1986;15: 717–20.CrossRefGoogle ScholarPubMed
8.Stock, LM, Bradley, GE, Lewis, RJ, Baker, DW, Sipsey, J, Stevens, CD. Patients who leave emergency departments without being seen by a physician: magnitude of the problem in Los Angeles County. Ann Emerg Med 1994;23:294–8.CrossRefGoogle ScholarPubMed
9.Demetrios, NK, Vena, R, Pamela, LD, Maureen, DM, David, AT. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med 1999;34:326–35.Google Scholar
10.Hobbs, D, Kunzman, SC, Tandberg, D, Sklar, D. Hospital factors associated with emergency center patients leaving without being seen. Am J Emerg Med. 2000;18: 767–72.Google Scholar
11.Spaite, DW, Bartholomeaux, F, Guisto, J, Lindberg, E, Hull, B, Eyherabide, A, et al. Rapid process redesign in a university-based emergency department: decreasing waiting time ranges and improving patient satisfaction. Ann Emerg Med 2002;39:168–77.Google Scholar
12.Fernandes, CMB, Christenson, JM. Use of continuous quality improvement to facilitate patient flow through the triage and fast-track areas of an emergency department. J Emerg Med 1995;13: 847–55.CrossRefGoogle ScholarPubMed
13.Fernandes, CMB, Christenson, JM, Price, A. Continuous quality improvement reduces length of stay for fast-track patients in an emergency department. Acad Emerg Med 1996;3:258–3.Google Scholar
14.Fernandes, CM, Price, A, Christenson, JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med 1997;15:397–9.Google Scholar
15.Dershewitz, RA, Paichel, W. Patients who leave a pediatric emergency department without treatment. Ann Emerg Med 1986;15: 717–20.CrossRefGoogle ScholarPubMed
16.Sainsbury, SJ. Emergency department patients who leave without being seen: Are urgently ill or injured patients leaving without care? Mil Med 1990;155:460–4.CrossRefGoogle ScholarPubMed
17.McNamara, KJ. Patients leaving the ED without being seen by a physician: Is same-day follow-up indicated? Am J Emerg Med 1995;13:136–41.Google Scholar
18.Fernandes, CM, Daya, MR, Barry, S, Palmer, N. Emergency department patients who leave without seeing a physician: The Toronto Hospital experience. Ann Emerg Med 1994;24:1092–6.Google Scholar
19.Gravel, J, Bergeron, S, Amre, D, Gouin, S. Evaluation of the Canadian paediatric triage and acuity scale in an emergency department [abstract]. Acad Emerg Med 2002;9(5):523.Google Scholar