Time is of the essence: evaluation of emergency department triage and time performance in the preoperative management of acute abdomen

Abstract

Background: Acute abdomen is a time-critical condition, which requires prompt diagnosis, initiation of first-line preoperative therapy and expedient surgical intervention. The earliest opportunity to intervene occurs at presentation to the emergency department triage. The aim of this audit was to evaluate the relationship between emergency triage and time performance measures in the preoperative management of abdominal emergencies. Methods: Retrospective audit of time performance measures of key clinical events from emergency triage. Patient characteristics, elapsed time from triage to commencement of fluid resuscitation, intravenous antibiotics and emergency surgery and post-operative outcomes were obtained from review of operative medical records data over a 1-year duration. Results: There was variability in triage allocation of patients with acute abdomen requiring urgent surgery. Category 3 was the most commonly assigned triage category (65.6%). The majority of patients (94.8%) had initial clinical assessment within the National Emergency Access Target '4-hour' rule, and 41.7% seen within 1-h from triage. Despite this, in cases of intra-abdominal sepsis, there was nearly a fourfold elapsed time for first dose intravenous antibiotics, beyond the 1-h recommendation in the Sepsis Kills pathway. There was nonsignificant trend in faster overall time performances with successive higher triage category allocation. Conclusion: This study highlights an opportunity to consider alternative triage methods or fast-track of patients with acute abdomen to promote early surgical assessment, resuscitation, antibiotic therapy and definitive intervention.

Acute abdominal pain in triage: A retrospective observational study of the Manchester triage system’s validity

“…AAP can be a presenting symptom in many diseases, ranging from mild gastroenteric illnesses to life‐threatening diseases (Palmer & Pontius, 2016). Up to 40% of patients with AAP experience a nonspecific clinical pattern that does not correlate well with the severity of the underlying disease (Teo et al, 2019). The assessment of the patients with AAP is challenging due to the possible involvement of different organs (e.g.…”

“…liver, bowel, pancreas) and the possible presence of different physiopathological processes (e.g. infection, necrosis, obstruction) whose evolution is often complex (Banz et al, 2011; Teo et al, 2019). Therefore, the evaluation of a patient with AAP should use clinical tools that can provide a comprehensive view of the diverse signs and symptoms involved and anticipate the clinical evolution of the syndrome.…”

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

“…This is undoubtedly a challenge for the triage and evaluation of emergency care, and it requires highly capable nurses. There have been many studies on the accuracy of triage of patients with acute abdomen [7][8][9] , but they are still constantly seeking and exploring better evaluation methods to improve the accuracy of pre-examination and triage. In 2018, China issued the "Expert Consensus on Emergency Pre-examination and Triage" [10] , which defined the standards for emergency pre-examination and triage.…”