Applying Sydney Triage to Admission Risk Tool (START) to improve patient flow in emergency departments: a multicentre randomised, implementation study

Abstract

Abstract Background To determine the effectiveness of applying the Sydney Triage to Admission Risk Tool (START) in conjunction with senior early assessment in different Emergency Departments (EDs). Methods This multicentre implementation study, conducted in two metropolitan EDs, used a convenience sample of ED patients. Patients were randomised to either the intervention or control group. Patients in the intervention group who were identified at triage as likely to require in-patient admission, based on START, were briefly assessed by the ED Consultant to confirm the likely admission and the in-patient specialist service the patient would be most likely admitted under. Bed management were then notified to begin bed finding and allocation. Patients in the control group were admitted under standard practices, although the START score was calculated by the investigator, this was only for descriptive purposes. Outcomes measured were ED length of stay and proportion of patients correctly identified as an in-patient admission by START. Results A total of 773 patients were evaluated using the START tool at triage across both sites (Intervention group n = 355 and control group n = 418 patients). The intervention group was associated with a reduced ED length of stay when compared to the control group (351 mins, interquartile range (IQR) 221.0–565.0 mins versus 383 mins, IQR 229.25–580.0 mins; p = 0.85). When stratified into admitted and discharged patients, similar results were seen. Conclusion In this extension of the START model of care implementation study in two metropolitan EDs, START, when used in conjunction with senior early assessment was associated with some reduced ED length of stay.