Kalan Laila, Chahine Racha A, Lasfer Chafika
Trauma and Orthopaedics, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR.
Quality and Risk Management, Fakeeh University Hospital, Dubai, ARE.
Cureus. 2024 Jan 25;16(1):e52921. doi: 10.7759/cureus.52921. eCollection 2024 Jan.
A systematic and straightforward triage system is crucial for the proper and timely care of patients within the emergency department (ED). This study unfolds a detailed understanding of the impact of the Canadian Triage and Acuity Scale (CTAS) on patient care and resource allocation in a private tertiary hospital. To the best of our knowledge, this is the only article studying the impact of the CTAS in one of the private hospitals in the United Arab Emirates (UAE) to achieve triage optimisation strategies. There is scope for further research in both public and private hospitals in the UAE. A triage system not only helps healthcare professionals prioritise cases conveniently but also guides patients to the most suitable area for a consultation. As a general rule, EDs follow an algorithm for the purpose of triage, and the aim of our study is to assess one such five-level triage system, CTAS, for its effectiveness and relevance during overcrowding in a UAE ED.
Within a period of approximately three weeks, a total of 351 CTAS-triaged patients were included in a prospective observational study during peak hours (17:00-22:00) of an ED in the UAE. The CTAS app was used as the triage tool to assess relevance, in terms of patient waiting times, resource allocation, and urgency level distribution, to the Canadian scale. All patients presenting to the ED were included with no exclusion criteria. The relationship between urgency level, duration of visit, and resources used was assessed, and the department's triage results were compared with those of the CTAS app.
Our sample showed a female (187; 53.3%) and adult preponderance (215; 61.3%) with most of the adult patients aged between 30 and 40 (96; 44.65%). 41.5% (145) of the triage was mismatched between the department and the CTAS app with 115 (79.3%) cases of under-triaging and 30 (20.7%) cases of over-triaging. There was a statistically significant difference (p=0.004) between average waiting times across triage categories 4 and 5 with the former category patients waiting for a longer period of time. Cohen's kappa showed moderate inter-relatability (k=0.42). The average utilisation costs per triage category showed a positive correlation with the urgency level for CTAS (Pearson's r=0.59); however, the costs declined as the urgency level rose for the department.
The high compliance rate demonstrates that the CTAS can be applicable to institutions outside of Canada. The categorisation of patients by the CTAS and their resource allocation were more accurate than the standard triage proving its effectiveness as a triage tool. Lack of synchronisation among the triage nurses and inadequate triage training are the most plausible reasons for this comparison. The recommended "time to be seen by a physician" was achievable in our ED, and that, along with the expected relationship between CTAS and resource utilisation, can be seen as valid indicators for a quality triage system for use in the UAE.
一个系统且直接的分诊系统对于急诊科患者的妥善及时护理至关重要。本研究深入了解了加拿大分诊与 acuity 量表（CTAS）对一家私立三级医院患者护理及资源分配的影响。据我们所知，这是唯一一篇研究 CTAS 在阿拉伯联合酋长国（阿联酋）一家私立医院中影响以实现分诊优化策略的文章。阿联酋的公立医院和私立医院都有进一步研究的空间。分诊系统不仅有助于医护人员方便地对病例进行优先级排序，还能引导患者前往最合适的区域进行咨询。一般来说，急诊科遵循一种分诊算法，我们研究的目的是评估这样一种五级分诊系统 CTAS 在阿联酋急诊科拥挤期间的有效性和相关性。
在大约三周的时间内，在阿联酋一家急诊科的高峰时段（17:00 - 22:00），共有 351 例经 CTAS 分诊的患者被纳入一项前瞻性观察研究。CTAS 应用程序被用作分诊工具，以评估在患者等待时间、资源分配和紧急程度分布方面与加拿大量表的相关性。所有前往急诊科就诊的患者均被纳入，无排除标准。评估了紧急程度、就诊时长与所使用资源之间的关系，并将科室的分诊结果与 CTAS 应用程序的结果进行了比较。
我们的样本显示女性占多数（187 例；53.3%）且成年人居多（215 例；61.3%），大多数成年患者年龄在 30 至 40 岁之间（96 例；44.65%）。科室与 CTAS 应用程序之间 41.5%（145 例）的分诊不匹配，其中 115 例（79.3%）为分诊不足，30 例（20.7%）为分诊过度。分诊类别 4 和 5 的平均等待时间之间存在统计学显著差异（p = 0.004），前一类别的患者等待时间更长。科恩 kappa 系数显示中等相关性（k = 0.42）。每个分诊类别的平均使用成本与 CTAS 的紧急程度呈正相关（皮尔逊 r = 0.59）；然而，科室的成本随着紧急程度的上升而下降。
高依从率表明 CTAS 可应用于加拿大以外的机构。CTAS 对患者的分类及其资源分配比标准分诊更准确，证明了其作为分诊工具的有效性。分诊护士之间缺乏同步以及分诊培训不足是这种比较最合理的原因。在我们的急诊科，推荐的“见到医生的时间”是可以实现的，并且这一点以及 CTAS 与资源利用之间的预期关系可被视为阿联酋优质分诊系统的有效指标。
