Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.
Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, 600 University Avenue Room 206, Toronto, ON, M5G 1X5, Canada.
CJEM. 2021 Mar;23(2):214-218. doi: 10.1007/s43678-020-00043-1. Epub 2021 Jan 8.
To explore the impact of the implementation of eCTAS, a real-time electronic decision-support tool, on hospital admission, rate of left without being seen, and time from triage to physician initial assessment.
We conducted a cohort study using population-based administrative data from all Ontario emergency departments (EDs) that had implemented eCTAS for 9 months. We compared 6 months post-eCTAS data to the same 6 months the previous year (pre-eCTAS). We included triage encounters of adult (≥ 18 years) patients if they had one of 16 pre-specified, high-volume presenting complaints. Multivariable logistic regression and quantile regression models informed the effect of eCTAS on outcomes.
We included data from 354,176 triage encounters from 31 EDs. There was a change in the distribution of triage scores post-eCTAS, with fewer patients classified as CTAS 2 and CTAS 3, and more patients classified as CTAS 1 and CTAS 4. Overall, hospital admission decreased post-eCTAS (adjusted OR: 0.98; 95% CI: 0.97 to 1.00), with fewer CTAS 2 and more CTAS 3 and CTAS 4 patients admitted post-eCTAS. The rate of left without being seen increased (2.8% vs. 3.0%; adjusted OR: 1.07; 95% CI: 1.03 to 1.11) post-eCTAS, while time to physician initial assessment proved similar pre and post-eCTAS.
eCTAS implementation had little impact on admission, rate of left without being seen and time to physician initial assessment. eCTAS appears to reclassify patients from higher to lower acuity scores, resulting in higher admission rates for CTAS 3 and CTAS 4 patients. It remains unknown if this reclassification is appropriate.
探索实时电子决策支持工具 eCTAS 的实施对住院、未就诊离开率以及从分诊到医生初步评估的时间的影响。
我们使用实施 eCTAS 9 个月的安大略省所有急诊部的基于人群的行政数据进行了队列研究。我们将 eCTAS 实施后 6 个月的数据与前一年同期的 6 个月数据进行了比较。我们纳入了有 16 种预先指定的高流量就诊主诉之一的成年（≥18 岁）患者的分诊就诊。多变量逻辑回归和分位数回归模型告知了 eCTAS 对结果的影响。
我们纳入了来自 31 个急诊部的 354176 次分诊就诊的数据。eCTAS 后分诊评分的分布发生了变化，CTAS 2 和 CTAS 3 患者减少，CTAS 1 和 CTAS 4 患者增多。总体而言，eCTAS 后住院率下降（调整后的 OR：0.98；95%CI：0.97 至 1.00），eCTAS 后 CTAS 2 和 CTAS 3 和 CTAS 4 患者的住院人数减少。eCTAS 后未就诊离开率增加（2.8%比 3.0%；调整后的 OR：1.07；95%CI：1.03 至 1.11），而分诊到医生初步评估的时间在 eCTAS 前后相似。
eCTAS 的实施对住院、未就诊离开率和医生初步评估时间几乎没有影响。eCTAS 似乎将患者从更高的严重程度重新分类为较低的严重程度评分，导致 CTAS 3 和 CTAS 4 患者的住院率更高。尚不清楚这种重新分类是否合适。
