Pediatric Reverse Triage—Uncomfortable but Real Decision Making for Community Preparedness

Burkle, Frederick M.

doi:10.1001/jamapediatrics.2016.4839

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…Mean LOS was 12 [8][9][10][11][12][13][14][15][16][17][18][19][20] days: LOS was significantly shorter in HDU patients (9 [6][7][8][9][10][11][12][13][14][15][16] in HDU, 15 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] in Ger, 12 [8][9][10][11][12][13][14][15][16]…”

Section: Follow-up and Outcomesmentioning

confidence: 99%

“…Discharge happened by a median of 7 [4][5][6][7][8][9][10][11][12][13] days after t 0 in the whole population (5 [3][4][5][6][7][8][9][10][11][12] days after t 0 in HDU, 8 [4][5][6][7][8][9][10][11][12][13][14][15] days after t 0 in Ger, 8 [5][6][7][8][9][10][11][12][13] days after t 0 in IM, respectively, P = 0.084 according to Kruskal-Wallis test). Table 3 describes the type of post-discharge care provided.…”

Section: Follow-up and Outcomesmentioning

confidence: 99%

“…While in disaster setting a risk of CME of 12% (class 2) could be tolerated, RT has been proposed to cope with daily surge with a lower cut‐off (<4% risk of CME—class 1), as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] The classification system includes five categories expressing the CME risk as increasing percentage (class 1 CME risk <4% to class 5 CME risk >90%). 5 While in disaster setting a risk of CME of 12% (class 2) could be tolerated, [6][7][8][9][10] RT has been proposed to cope with daily surge with a lower cut-off (<4% risk of CME-class 1), as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks. [10][11][12][13][14] Nevertheless, while it is well known that appropriate discharge of inpatients could decrease the delay to admission and reduce ED crowding and related adverse events, no universal consensus about safe early discharge criteria exists.…”

mentioning

confidence: 99%

“…5 While in disaster setting a risk of CME of 12% (class 2) could be tolerated, [6][7][8][9][10] RT has been proposed to cope with daily surge with a lower cut-off (<4% risk of CME-class 1), as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks. [10][11][12][13][14] Nevertheless, while it is well known that appropriate discharge of inpatients could decrease the delay to admission and reduce ED crowding and related adverse events, no universal consensus about safe early discharge criteria exists. The decision whether or not a hospitalised patient is appropriate for discharge requires evaluation of multiple factors involving medical, as well as psychosocial, logistic, and economic considerations.…”

mentioning

confidence: 99%

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Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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Summary Background Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. Material and methods We prospectively assessed every 4 days (t0) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. Results Twenty‐five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty‐four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. Conclusions Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.

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Section: Follow-up and Outcomesmentioning

confidence: 99%

Section: Follow-up and Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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Comparison of Reverse Triage with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index to classify medical inpatients of an Italian II level hospital according to their resource’s need

et al. 2019

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Background:Resource allocation in our overcrowded hospitals would require classification of inpatients according to the severity of illness, the evolving risk and the clinical complexity. Reverse triage (RT) is a method used in disasters to identify inpatients according to their use of hospital resources.The aim of this observational prospective study is to evaluate the use of RT in medical inpatients of an Italian Hospital and to compare the RT score with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index. Material and Methods: Cluster sampling was performed on High Dependency Unit (HDU), Geriatrics (Ger) and Internal Medicine (IM) wards. We calculate RT, NEWS, SOFA and CCI from inpatient charts. Length of stay (LOS), transfer to a higher level of care, death and discharge date were collected after 30 days. Results: We obtained demographics, comorbidities, severity and clinical complexity of 260 inpatients. We highlighted differences in NEWS, SOFA and CCI in the three divisions. On the contrary RT score was uniformly high (median 7), with 85% of patients with RT=8. NEWS, SOFA and CCI were higher in patients with higher RT score. We used the sum of the interventions listed by RT (RT sum) as a proxy of the level of care needed. RT-sum showed moderate correlation with NEWS (r=0,52 Spearman, p<0,001). RT-sum was the highest in HDU, related to the evolving severity of HDU patients. Ger patients, that showed the highest CCI score (with all patients in the CCI ≥3 category) had the second highest RT-sum. Conclusions: RT score showed similar values in the majority of the inpatients regardless of differences in NEWS, SOFA and CCI in different ward subgroups. RT-sum is related both to evolving severity (NEWS) and to clinical complexity (CCI). RT and NEWS could predict inpatient level of care and resource need associated with CCI.

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Children and Disaster

Bouton¹,

Cooper²

2024

Ciottone's Disaster Medicine

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Pediatric Reverse Triage—Uncomfortable but Real Decision Making for Community Preparedness

Cited by 5 publications

References 6 publications

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

Comparison of Reverse Triage with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index to classify medical inpatients of an Italian II level hospital according to their resource’s need

Children and Disaster

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