The Mount Sinai Hospital, Department of Emergency Medicine, New York, New York.
New York-Presbyterian Hospital, Columbia University Irving Medical Center, Department of Biomedical Informatics, New York, New York.
West J Emerg Med. 2022 Feb 28;23(2):145-151. doi: 10.5811/westjem.2021.12.53873.
Early rooming triage increases patient throughput and satisfaction by rapidly assigning patients to a definitive care area, without using vital signs or detailed chart review. Despite these operational benefits, the clinical accuracy of early rooming triage is not well known. We sought to measure the accuracy of early rooming triage and uncover additional patient characteristics that can assist triage.
We conducted a single-center, retrospective population study of walk-in emergency department (ED) patients presenting to the ED via an early rooming triage system, examining triage accuracy and demographic factor correlation with higher acuity ED outcomes.
Among all patients included from the three-year study period (N = 238,457), early rooming triage was highly sensitive (0.89) and less specific (0.61) for predicting which patients would have a severe outcome in the ED. Patients triaged to the lowest acuity area of the ED experienced severe outcomes in 4.39% of cases, while patients triaged to the highest acuity area of the ED experienced severe outcomes in 65.9% of cases. An age of greater than 43 years (odds ratio [OR] 3.48, 95% confidence interval: 3.40, 3.57) or patient's home address farther from the ED ([OR] 2.23 to 3.08) were highly correlated with severe outcomes. Multivariable models incorporating triage team judgment were robust for predicting severe outcomes at triage, with an area under the receiver operating characteristic of 0.82.
Early rooming workflows are appropriately sensitive for ED triage. Consideration of demographic factors, automated or otherwise, can augment ED processes to provide optimal triage.
早期分诊可通过快速将患者分配到特定护理区域，而无需使用生命体征或详细的图表审查，从而提高患者吞吐量和满意度。尽管具有这些运营优势，但早期分诊的临床准确性尚不清楚。我们旨在衡量早期分诊的准确性，并发现可以协助分诊的其他患者特征。
我们进行了一项单中心、回顾性的人群研究，研究对象为通过早期分诊系统就诊的急诊部（ED）的走急诊患者，检查分诊准确性以及与 ED 高严重程度结局相关的人口统计学因素相关性。
在为期三年的研究期间（N=238457），所有纳入的患者中，早期分诊对预测哪些患者在 ED 中会有严重结局的敏感性非常高（0.89），特异性较低（0.61）。分诊到 ED 最低严重程度区域的患者中，有 4.39%的患者出现严重结局，而分诊到 ED 最高严重程度区域的患者中，有 65.9%的患者出现严重结局。年龄大于 43 岁（比值比[OR]3.48，95%置信区间：3.40，3.57）或患者家庭住址距离 ED 较远（[OR]2.23 至 3.08）与严重结局高度相关。纳入分诊团队判断的多变量模型在分诊时预测严重结局的表现稳健，接收者操作特征曲线下的面积为 0.82。
早期分诊工作流程对 ED 分诊具有适当的敏感性。考虑人口统计学因素，无论是自动化还是其他方式，都可以增强 ED 流程，以提供最佳分诊。
