Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

Author:

Savioli Gabriele1ORCID,Ceresa Iride Francesca2ORCID,Bressan Maria Antonietta1,Piccini Gaia Bavestrello3ORCID,Varesi Angelica3ORCID,Novelli Viola4ORCID,Muzzi Alba4,Cutti Sara4,Ricevuti Giovanni5ORCID,Esposito Ciro6,Voza Antonio7ORCID,Desai Antonio89,Longhitano Yaroslava10ORCID,Saviano Angela11ORCID,Piccioni Andrea11ORCID,Piccolella Fabio10,Bellou Abdel1213,Zanza Christian10,Oddone Enrico14ORCID

Affiliation:

1. Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy

2. Department of Emergency, Ospedale Civile, 27029 Vigevano, Italy

3. Faculty of Medicine, University of Pavia, 27100 Pavia, Italy

4. Health Department, University of Pavia, 27100 Pavia, Italy

5. Department of Drug Science, University of Pavia, 27100 Pavia, Italy

6. Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy

7. Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy

8. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy

9. Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy

10. Department of Anesthesiology and Intensive Care Medicine—AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy

11. Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy

12. Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China

13. Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA

14. Department of Public Health, Experimental and Forensic Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy

Abstract

Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.

Publisher

MDPI AG

Subject

General Medicine

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