Can a reverse triage clinical decision support tool create sufficient surge capacity and reduce emergency department crowding?

Bondt, Frieda De; Pollaris, Gwen; Sabbé, Marc

doi:10.1097/mej.0000000000000855

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…However, being a physician in an emergency department is also experienced as being the one who must dare to take a stand and make the difficult decision, which is described as making choices even in cases where the diagnosis is hard to determine or where it is difficult to determine the right method. According to Bondt et al ( 2021 ), non-specificity risk profiling can be a way to support difficult decisions. This is a strategy to identify patients with the lowest risk of complications.…”

Section: Discussion: What Enables the Becoming Of Supar As An Object ...mentioning

confidence: 99%

“…Due to the large numbers of patients in the emergency department, achieving flow and avoiding crowding is an organizational concern where low length of stay is considered essential (Lindstrøm et al 2021 ) and triage strategies and monitoring of the influx of patients are considered as vital management tools in an emergency department (De Bondt et al 2021 ).…”

Section: Background: Supar In the Emergency Departmentmentioning

confidence: 99%

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Challenges facing the clinical adoption of a new prognostic biomarker: a case study

et al. 2023

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In this article, we show how a particular biomarker comes into being in an emergency department in a hospital in Copenhagen, Denmark. We explore the contextual becoming of this biomarker, suPAR, through interviews with nurses and physicians and through relational ontology. We find that as a prognostic biomarker suPAR is challenged in it becoming as an object for clinical practice in the emergency department by the power of diagnostic practices and the desire for experience-based scripts that quickly enable the clinician to reach the right diagnosis. Although suPAR is enacted as a promising triage strategy suggesting a low or high risk of disease, the inability to rule out specific diagnoses and producing the notion of secure clinical actions make its non-specificity and prognostic character problematic in clinical practices. Specific diagnostic criteria versus prognostic interpretation and non-specificity risk profiling challenges the way healthcare workers in an emergency department understand the tasks they are set to solve and how to solve them. We discuss how the becoming of suPAR is strengthened through enactments of specificity and engagement in triage strategies and we reflect on it’s becoming through new diagnostic practices with the need to accommodate diagnostic ambiguity.

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Section: Discussion: What Enables the Becoming Of Supar As An Object ...mentioning

confidence: 99%

Section: Background: Supar In the Emergency Departmentmentioning

confidence: 99%

Challenges facing the clinical adoption of a new prognostic biomarker: a case study

et al. 2023

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“…Applying RT selection to identifying inpatients who do not need in-hospital interventions for the coming days has been studied for MCIs before, but some have stated that it can be useful for coping with daily surges as well. By simultaneously prioritizing ED patients who need urgent medical care and hospitalized patients ready for discharge, a daily hospital surge capacity could be achieved (13). Nevertheless, early discharge could increase the risk of developing a CME which would require a readmission, an additional burden for the already-strained ED (10).…”

Section: Rt and Ed Crowdingmentioning

confidence: 99%

“…The RT score had a high specificity (95%) on its own, but it was even higher when associated with readmission screening tools (10). As the tolerated risk of 12% for developing a CME in a disaster setting will not be tolerable in ED crowding situations, a lower cutoff of <4% has been proposed for daily crowding (1,13,20). Furthermore, a Delphi study with a European expert panel recently discussed early discharge criteria within a universal patient disposition classification system that will be applicable for MCI and daily crowding (12,13).…”

Section: Rt and Ed Crowdingmentioning

confidence: 99%

Reverse triage: a systematic review of the literature

Pollaris,

De Bondt,

Sabbe

2023

Front. Disaster Emerg. Med.

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BackgroundMany techniques to increase hospital surge capacity in the case of a mass casualty incident (MCI) have already been studied, but a new technique, reverse triage, has gained attention. The objective of this systematic review is to provide a comprehensive literature overview regarding the use of the reverse triage principle in emergency and disaster medicine.MethodsA systematic literature review was carried out adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Publications up to May 2023 in the Medline, Embase, CENTRAL, CINAHL, and Web of Science databases were considered. The risk of bias was assessed using the Methodological Items for Non-Randomized Studies, the Risk of Bias Assessment Tool for Systematic Reviews, and Johanna Briggs Institute tools for observational, systematic reviews, and expert opinions respectively.ResultsThe initial search identified 21,259 unique records, of which 16 were included, consisting of 2 reviews, 5 expert opinions, and 9 observational studies. Across studies, an overall surge capacity of 20–30% could be achieved by implementing reverse triage and even more when combined with other strategies. Furthermore, the American framework that comprehended a safe discharge protocol for inpatients is being used in the development of new reverse triage discharge protocols. The risk of developing a complication (adverse event) due to early discharge is rather low.DiscussionDue to the heterogeneity of the included studies, the interpretation of the results should be taken with caution. The most prominent differences were related to study size, university affiliation, health care system, and patient characteristics. Nevertheless, implementing the reverse triage principle in MCIs to guide early discharge of adult inpatients can create additional surge capacity with a minor occurrence of adverse events. A final assessment by a multidisciplinary discharge team (nurses and physicians) remains crucial.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022294136, identifier: CRD42022294136.

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“…A mandatory rule for patient admission in less than 4 h after ED arrival for at least 95% of patients has been implemented in Great Britain as well as Australia and had a favourable impact on in-hospital mortality [12,13]. New tools are investigated in order to improve patient flow through the ED and reduce the harms of crowding [14,15].…”

Section: Introductionmentioning

confidence: 99%

Impact of emergency department length of stay on in-hospital mortality: a retrospective cohort study

Balen,

Routoulp,

Charpentier

et al. 2023

European Journal of Emergency Medicine

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Background and importance Emergency Department (ED) workload may lead to ED crowding and increased ED length of stay (LOS). ED crowding has been shown to be associated with adverse events and increasing mortality. We hypothesised that ED-LOS is associated with mortality. Objective To study the relationship between ED-LOS and in-hospital mortality. Design Observational retrospective cohort study. Settings and participants From 1 January 2015 to 30 September 2018, all visits by patients aged 15 or older to one of the two ED at Toulouse University Hospital were screened. Patients admitted to the hospital after ED visits were included. Visits followed by ED discharge, in-ED death or transfer to ICU or another hospital were not included. Outcome measure and analysis The primary outcome was 30-day in-hospital mortality. ED-LOS was defined as time from ED registration to inpatient admission. ED-LOS was categorised according to quartiles [<303 min (Q1), between 303 and 433 minutes (Q2), between 434 and 612 minutes (Q3) and >612 min (Q4)]. A multivariable logistic regression tested the association between ED-LOS and in-hospital mortality. Main results A total of 49 913 patients were admitted to our hospital after ED visits and included in the study. ED-LOS was not independently associated with in-hospital mortality. Compared to ED-LOS < 303 min (Q1, reference), odd-ratios (OR) [95% CI] of in-hospital mortality for Q2, Q3, and Q4 were respectively 0.872 [0.747–1.017], 0.906 [0.777–1.056], and 1.137 [0.985–1.312]. Factors associated to in-hospital mortality were: aged over 75 years (OR [95% CI] = 4.3 [3.8–4.9]), Charlson Comorbidity Index score > 1 (OR [95% CI] = 1.3 [1.1–1.5], and 2.2 [1.9–2.5] for scores 2 and ≥ 3 respectively), high acuity at triage (OR [95% CI] = 3.9 [3.5–4.4]), ED visit at Hospital 1 (OR [95% CI] = 1.6 [1.4–1.7]), and illness diagnosis compared to trauma (OR [95% CI] = 2.1 [1.7–2.6]). Night-time arrival was associated with decreased in-hospital mortality (OR [95% CI] = 0.852 [0.767–0.947]). Conclusion In this retrospective cohort study, there was no independent association between ED-LOS before admission to general non-ICU wards and in-patient mortality.

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Can a reverse triage clinical decision support tool create sufficient surge capacity and reduce emergency department crowding?

Cited by 6 publications

References 12 publications

Challenges facing the clinical adoption of a new prognostic biomarker: a case study

Challenges facing the clinical adoption of a new prognostic biomarker: a case study

Reverse triage: a systematic review of the literature

Impact of emergency department length of stay on in-hospital mortality: a retrospective cohort study

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