Predicting admission at triage: are nurses better than a simple objective score?

Abstract

GAPS, a simple clinical score, is a better predictor of admission than triage nurses, unless the nurse is sure about the outcome, in which case their clinical judgement should be respected.

Comparison of Glasgow Admission Prediction Score and Amb Score in predicting need for inpatient care

“…We knew from a previous study that GAPS’ receiving operator characteristic (ROC) would have an area under the curve (AUC) of about 0.85 14. Our database suggested that the correlation coefficient of GAPS and Ambs was approximately −0.4, with the ratio of discharges to admissions in our sample being close to 1.5.…”

“…As with any such clinical tool, however, its purpose is to support rather than supplant human judgement; previous work has indicated that combining GAPS with a veto from triage nurses would provide an accurate strategy for bed management 14. We suggest that future work should focus on implementation of this approach and impact on ‘front door’ performance.…”

“…It was derived from 322 000 unselected adult attendances to ED triage in Glasgow and has proved more accurate than nursing judgement in predicting ED discharge (table 1). 14 …”

Multicentre, prospective observational study of the correlation between the Glasgow Admission Prediction Score and adverse outcomes

“…These findings suggest that GAPS could be used to help inform clinicians and patients themselves of likely outcomes at an early stage in their hospital visit. GAPS could be utilised to improve flow in the ED, for example, by directing low-risk patients to an ambulatory emergency care facility or urgent clinic, by giving junior clinicians a clearer idea of prognosis to support discharge decisions or by directing senior clinicians to the patients to whose care they are most likely to add the most value 28–30…”

“…Furthermore, GAPS has been found to be an accurate predictor of patient disposition and has been found to be superior to triage nurses’ ability to predict admission at the point of triage. In addition, GAPS is currently being used at a number of UK sites, including Glasgow, Sheffield, Nottingham and Torbay, to aid in patient streaming in the ED 28–30…”