Does the Canadian Emergency Department Triage and Acuity Scale identify non-urgent patients who can be triaged away from the emergency department?

Abstract

ABSTRACTIntroduction:Non-urgent visits comprise a significant proportion of visits to most emergency departments (EDs). Given the severe overcrowding issues faced by many EDs, the use of theCanadian Emergency Department Triage and Acuity Scale(CTAS) to identify patients who could be managed elsewhere seems to be an obvious way to reduce the pressure on the ED and “solve” the overcrowding problem.Objective:To quantify the resource implications, in terms of stretcher use and waiting times, related to non-urgent patient visits and to estimate the potential impact on ED flow of redirecting these patients to alternate primary care settings.Methods:Retrospective database audit in an urban referral hospital ED. For this study, patients triaged as either CTAS Levels IV or V were considered “non-urgent.”Results:Non-urgent patients comprised 30% of ED visits, but less than 5% of all those needing stretchers, along with their associated nursing resources. The longer waits consisted almost entirely of waits for available stretchers and would therefore have remained essentially unaffected. In spite of being labelled “non-urgent” by CTAS criteria, 7.3% of all patients requiring admission came from this group.Conclusions:Non-urgent patients consume a small fraction of the ED stretchers and acute-care resources; therefore, strategies aimed at diverting non-urgent patients are unlikely to improve access for more urgent patients. Using the CTAS to identify patients for diversion away from the ED is measurably unsafe and will lead to inappropriate refusal of care for many patients requiring hospital treatment.