Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Dedalus HealthCare, Bonn, Germany.
J Med Internet Res. 2024 May 14;26:e45593. doi: 10.2196/45593.
The use of triage systems such as the Manchester Triage System (MTS) is a standard procedure to determine the sequence of treatment in emergency departments (EDs). When using the MTS, time targets for treatment are determined. These are commonly displayed in the ED information system (EDIS) to ED staff. Using measurements as targets has been associated with a decline in meeting those targets.
This study investigated the impact of displaying time targets for treatment to physicians on processing times in the ED.
We analyzed the effects of displaying time targets to ED staff on waiting times in a prospective crossover study, during the introduction of a new EDIS in a large regional hospital in Germany. The old information system version used a module that showed the time target determined by the MTS, while the new system version used a priority list instead. Evaluation was based on 35,167 routinely collected electronic health records from the preintervention period and 10,655 records from the postintervention period. Electronic health records were extracted from the EDIS, and data were analyzed using descriptive statistics and generalized additive models. We evaluated the effects of the intervention on waiting times and the odds of achieving timely treatment according to the time targets set by the MTS.
The average ED length of stay and waiting times increased when the EDIS that did not display time targets was used (average time from admission to treatment: preintervention phase=median 15, IQR 6-39 min; postintervention phase=median 11, IQR 5-23 min). However, severe cases with high acuity (as indicated by the triage score) benefited from lower waiting times (0.15 times as high as in the preintervention period for MTS1, only 0.49 as high for MTS2). Furthermore, these patients were less likely to receive delayed treatment, and we observed reduced odds of late treatment when crowding occurred.
Our results suggest that it is beneficial to use a priority list instead of displaying time targets to ED personnel. These time targets may lead to false incentives. Our work highlights that working better is not the same as working faster.
分诊系统（如曼彻斯特分诊系统（MTS））的使用是确定急诊科（ED）治疗顺序的标准程序。在使用 MTS 时，会确定治疗的时间目标。这些目标通常在 ED 信息系统（EDIS）中显示给 ED 工作人员。使用测量值作为目标与未能达到这些目标的情况减少有关。
本研究调查了向医生显示治疗时间目标对 ED 处理时间的影响。
我们在德国一家大型地区医院引入新的 EDIS 期间，进行了一项前瞻性交叉研究，分析了向 ED 工作人员显示时间目标对等待时间的影响。旧的信息系统版本使用一个模块显示 MTS 确定的时间目标，而新系统版本则使用优先级列表。评估基于从干预前期间收集的 35167 份常规电子健康记录和干预后期间的 10655 份记录。从 EDIS 中提取电子健康记录，使用描述性统计和广义加性模型分析数据。我们根据 MTS 设置的时间目标评估干预对等待时间和及时治疗可能性的影响。
当使用不显示时间目标的 EDIS 时，ED 停留时间和等待时间增加（从入院到治疗的平均时间：干预前阶段=中位数 15，IQR 6-39 分钟；干预后阶段=中位数 11，IQR 5-23 分钟）。然而，具有高紧迫性（如分诊评分所示）的严重病例从较低的等待时间中受益（MTS1 为干预前时期的 0.15 倍，MTS2 仅为 0.49 倍）。此外，这些患者接受延迟治疗的可能性较低，并且我们观察到当拥挤发生时，延迟治疗的可能性降低。
我们的结果表明，使用优先级列表而不是向 ED 人员显示时间目标是有益的。这些时间目标可能会导致错误的激励。我们的工作强调，更好地工作并不等同于更快地工作。
