Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines

Bullard, Michael J.; Chan, Tom; Brayman, Colleen; Warren, David; Musgrave|RN, Erin; Unger, Bernard; Group, Members of the CTAS National Working

doi:10.1017/s148180350000350x

Cited by 101 publications

(113 citation statements)

References 9 publications

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“…The CTAS was first implemented in 1999 in Canada and most recently revised in 2014 6. CTAS assigns acuity level of 1–5 (1 being the most urgent) using subjective and objective evaluation of chief complaint in conjunction with physiologic and historical modifiers.…”

Section: Methodsmentioning

confidence: 99%

‘Down-triage’ for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan

et al. 2016

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Objective Assessment of abnormal vital signs in triage is a challenge in the paediatric emergency department (PED), since vital signs may reflect anxiety, fever or pain rather than the clinical deterioration of the child. We aimed to evaluate the efficacy of subjective 'down-triage' (change of the initially determined acuity levels) of Japanese Triage and Acuity Scale ( JTAS). Methods This is a retrospective cohort study of patients in PED up to 15 years of age at a tertiary paediatric medical centre in Japan during a 1-year period. At the end of every JTAS triage process, PED nurses were allowed to 'down-triage' acuity levels of well-appearing patients with abnormal HR or RR, which were presumably attributable to fever, crying or being upset. We compared predictive performance of the triage system before and after 'down-triage' using admission rate as the primary outcome. Results Among 37 961 PED visits during the study period, we analysed 37 219 records. A total of 17 089 patients (45.9%) were 'down-triaged' after their initial triage allocation upon arrival. Admission rates after 'down-triage' (83%, 33%, 7%, 1% and 3% for levels 1-5, respectively), compared with those of unmodified initial level (16%, 11%, 6%, 2% and 6% for levels 1-5, respectively), had a better apparent relevance with the anticipated admission rates of Canadian Triage and Acuity Scale. Conclusions Modification of JTAS through 'downtriage' by experienced staff improves prediction of disposition in a PED. Further research is needed to determine an objective protocol for 'down-triage' to ensure safe practice in a PED.

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Section: Methodsmentioning

confidence: 99%

‘Down-triage’ for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan

et al. 2016

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“…Home care billing records were used to identify which home care services a patient received on each day, including nursing, personal support and therapies (physiotherapy, occupational therapy, speech and language therapy, nutritional therapy and social work). The cohort was linked to emergency department records to identify any day that a patient visited the emergency department after 5 pm and to identify the Canadian Triage and Acuity Scale (CTAS) 25 score, discharge disposition and primary diagnosis (International Statistical Classification of Diseases and Related Health Problems, 10th revision [ICD-10-CA]) 26 associated with the visit. In the rare case that a patient visited the emergency department twice after 5 pm on the same day, only the first visit was included.…”

Section: Participantsmentioning

confidence: 99%

The association between home care visits and same-day emergency department use: a case–crossover study

Jones

Schumacher

Bronskill

et al. 2018

CMAJ

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“…We believe that the analogy of an "air traffic control office" captures our goal for an intake and triage system, rather than multiple individual runways of arrivals and departures to our services. One existing approach for triage used in emergency rooms is the Canadian Triage and Acuity Scale (Bullard et al 2014) and Canadian Emergency Department Information Systems (CEDIS) identifiers for mental health. In addition, some practitioners are also using the level of care utilization system (LOCUS) tool (American Association of Community Psychiatrists 2010).…”

Section: Intake/triage Processmentioning

confidence: 99%

Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital

Ungar

Taube-Schiff

Stergiopoulos

2017

FACETS

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We have applied a Bauhaus design lens to inform a visual conceptual framework for a rational mental health care system. We believe that Canada's healthcare system can often be fragmented and does not always allow for service delivery to easily meet patient care needs. Within our proposed framework, the form of services provided follows patient-and healthcare-centred needs. The framework is also informed by the ethics and values of social responsibility, population health, and principles of quality of care. We review evidence for this framework (based on need, acuity, risk, service intensity, and provider level) and describe patient care pathways from intake/triage to three patient-centred tiers of care: (1) primary care (low needs), (2) acute ambulatory transitional care (moderate needs), and (3) acute hospital and complex care (high needs). Within each tier, various models of care are organized from low to high service intensity as informed by reports from the British Columbia Ministry of Health and the World Health Organization. We hope that our model may help to better conceptualize and organize our mental health care system and help providers clarify roles, responsibilities, and accountabilities to improve quality of care.

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Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines

Cited by 101 publications

References 9 publications

‘Down-triage’ for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan

‘Down-triage’ for children with abnormal vital signs: evaluation of a new triage practice at a paediatric emergency department in Japan

The association between home care visits and same-day emergency department use: a case–crossover study

Applying a Bauhaus design approach to conceptualize an integrated system of mental health care: Lessons from a large urban hospital

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