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

Bullard, Michael J.; Unger, Bernard; Spence, Julie; Grafstein, Eric

doi:10.1017/s1481803500009854

Cited by 221 publications

(191 citation statements)

References 18 publications

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“…Le principal critère d'évaluation était le nombre médian de jours d'hospitalisation, et les critères d'évaluation secondaires consistaient en le nombre médian de jours passés dans un service de soins spécialisés, en la mortalité hospitalière au bout de 30 jours et en la proportion de patients dont l'état avait nécessité un relèvement du niveau de soins durant le séjour à l'hôpital. Résultats: Aucun écart n'a été enregistré entre les groupes en qui concerne le nombre médian de jours d'hospitalisation (3,8 contre [c.] 4,0 jours; p = 0,21) ou le nombre médian de jours passés dans un service de soins spécialisés (5,0 c. 5,6 jours; p = 0,42). Il n'y avait pas de différence non plus quant au pourcentage de la mortalité hospitalière (6,0 % c. 5,6 %; p = 0,66) ou à la fréquence du relèvement du niveau de soins en 24 heures (4,9 % c. 4,0 %; p = 0,52).…”

Section: Résuméunclassified

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Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Imperato

Mehegan

Henning³

et al. 2016

CJEM

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Background: Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs. Objectives: To determine if a clinical triggers program in the emergency department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician-led multidisciplinary team had a measurable effect on inpatient hospital metrics. Methods: The study design was a retrospective pre and post intervention study. The intervention was the implementation of an ED clinical "triggers" program. Abnormal vital sign criteria that warranted a trigger response included: heart rate <40 beats/minute or >130 beats/minutes, respiratory rate <8 breaths/minute or >30 breaths/minute, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was the median days admitted with secondary outcomes of median days in special care unit, in-hospital 30-day mortality and proportion of patients who required an upgrade in inpatient care level. Results: There was no difference in median days admitted for inpatient care (3.8 v. 4.0 days, p = 0.21) or median days spent in a special care unit (5.0 v. 5.6 days, p = 0.42) between the groups. There was no difference in the percentage of in-hospital patient deaths (6.0% v. 5.6%, p = 0.66) or frequency of upgrade in level of care within 24 hours (4.9% v. 4.0%, p = 0.52). Conclusions: In our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.

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Section: Résuméunclassified

“…Over the years, a number of ED triage scales have been created, revised, implemented, and studied in attempts to ensure the accuracy of triage categorization. [1][2][3][4][5][6][7] Vital signs are often included in triage assessments and help guide triage classification and resultant timeliness of provider evaluation.…”

Section: Introductionmentioning

confidence: 99%

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Imperato

Mehegan

Henning³

et al. 2016

CJEM

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“…Validation of the ITS led to its adoption as the National Triage Scale (NTS) [5][6] and subsequently the Australasian Triage Scale (ATS) [6][7]. This in turn formed the basis of the Manchester Triage Scale (MTS) [8] in the UK and the Canadian Triage and Acuity Scale (CTAS) [9][10][11] in Canada. Several international scales have developed from or been based upon the ATS.…”

Section: Introductionmentioning

confidence: 99%

Towards a resilient health status assessment employing intelligence in cyber physical systems

et al. 2018

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-Resilience is defined as the capacity of a system to cope with a hazardous event or disturbance, responding or reorganizing in ways that maintain its essential function, identity, and structure, while also maintaining the capacity for adaptation, learning and transformation. A resilient health system is one that is capable to anticipate, respond to, cope with, recover from and adapt to system-related shocks and stress, so as to bring sustained improvements in population health, despite the unstable circumstances. Nowadays, the emergency department (ED) of hospitals faces growing demands, rising acuteness and longer waiting times. An efficient, accurate and resilient triage system to improve the operation of the ED becomes crucial. In this work, a resilient system for automatic priority, sorting and monitoring of medical events -triage system-is developed, so that the patients in the ED are treated according to the severity of their condition and not by the order of attendance utilizing a Fuzzy Inference System (FIS) that aggregates, processes patients' vital signs as well as determines their Health Status (HS), according to which the ED staff performs the appropriate classification. IntroductionThe ED is an autonomous part of the hospital that aims to receive, revitalize, diagnose and treat patients with a variety of emergencies that cover the full range of diseases, injuries and disorders. Effective emergency response is a matter of utmost importance for the reliability of every health system. Nowadays, the ED faces serious problems due to the massive occurrence of incidents that create crowded conditions, increased waiting times and other undesirable effects. Increasing needs and requirements and increasing demands for healthcare monitoring and patient assistance pose challenges that need to be addressed by improving current health systems and infrastructures. The use of technology contributes effective and decisive to enhance the operation of ED. The need to provide a high level of medical services and the need for rapid and reliable recording of medical and other data, which data in ED can even judge the outcome of an incident, make the use of an appropriately adapted information system imperative. The development and exploitation of such a system is a significant improvement in the operation of the ED. During ED crowding and all the malfunctions it causes there is an imbalance between the need for emergency care and available resources, which enhances the need for accurate triage [1]. Triage is a process that is critical to the effective management of modern EDs. Triage systems are used in EDs to prioritize patients and to ensure that they are seen in order of clinical need when demand exceeds capacity. They do this by determining who will not be disadvantaged by longer waiting times and who requires immediate attention and urgent medical care to achieve optimal outcomes. There are several protocols and methods that are used for triage in EDs (ED Triage), which differ in both patient assessment cr...

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“…The CTAS consists of five triage levels combining severity of illness or risk with recommended fractile reponse times to medical assessment supported by a standardized patient presenting complaint list. 17,18 Level 1 is considered most urgent and Level 5 least urgent. Traditionally CTAS has been applied by trained triage nurses in hospital EDs.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services

Leeies

Ffrench

Strome

et al. 2016

CJEM

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Objectives: Triage is fundamental to emergency patient assessment. Effective triage systems accurately prioritize patients and help predict resource utilization. CTAS is a validated five-level triage score utilized in Emergency Departments (EDs) across Canada and internationally. Historically CTAS has been applied by triage nurses in EDs. Observational evidence suggests that the CTAS might be implemented reliably by paramedics in the prehospital setting. This is the first system-wide assessment of CTAS interrater reliability between paramedics and triage nurses during clinical practice. Methods: Variables were extracted from hospital and EMS databases. EMS providers determined CTAS on-scene, CTAS pre-transport, and CTAS on-arrival at hospital for each patient (N = 14,378). The hospital arrival EMS CTAS (CTAS arrival ) score was compared to the initial nursing CTAS score (CTAS initial ) and the final nursing CTAS score (CTAS final ) incuding nursing overrides. Interrater reliability between ED CTAS initial and EMS CTAS arrival scores was assessed. Interrater reliability between ED CTAS final and EMS CTAS arrival scores, as well as proportion of patient encounters with perfect or near-perfect agreement, were evaluated. Results: Our primary outcome, interrater reliability [kappa = 0.437 (p < 0.001, 95% CI 0.421-0.452)], indicated moderate agreement. EMS CTAS arrival and ED CTAS initial scores had an exact or within one point match 84.3% of the time. The secondary interrater reliability outcome between hospital arrival EMS CTAS (CTAS arrival ) score and the final ED triage CTAS score (CTAS final ) showed moderate agreement with kappa = 0.452 (p < 0.001, 95% CI 0.437-0.466). Conclusions: Interrater reliability of CTAS scoring between triage nurses and paramedics was moderate in this systemwide implementation study. RÉSUMÉObjectifs: Le triage est un élément essentiel de l'évaluation des patients au service des urgences. Des systèmes efficaces de triage permettent de classer exactement les patients en ordre de priorité et aident à prévoir l'utilisation des ressources. L'ECTG est une échelle à cinq niveaux, validée et appliquée dans les services des urgences (SU) partout au Canada et ailleurs dans le monde. Les infirmiers de triage l'utilisent depuis longtemps dans les SU. Or, d'après des données d'observation, les ambulanciers paramédicaux pourraient appliquer l'ECTG en milieu préhospitalier, et ce, d'une manière fiable. Il sera donc question ici de la première évaluation systémique de la fiabilité interévaluateurs, au regard de l'ECTG, entre ambulanciers paramédicaux et infirmiers de triage en pratique clinique. Méthode: Il y a eu extraction de variables provenant de bases de données d'hôpitaux et de SMU. Des fournisseurs de SMU ont déterminé, pour chacun des patients (n = 14 378), le degré de gravité (DG) selon l'ECTG sur les lieux de l'événement, avant le transport dans un SU et à l'arrivée à l'hôpital. Le DG assigné par les SMU selon l'ECTG à l'arrivée à l'hôpital (ECTG arrivée ) a été comparé au DG initial...

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

Abstract: This article has not been peer reviewed.

Cited by 221 publications

References 18 publications

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Can an emergency department clinical “triggers” program based on abnormal vital signs improve patient outcomes?

Towards a resilient health status assessment employing intelligence in cyber physical systems

Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services

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