Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-10T23:40:13.637Z Has data issue: false hasContentIssue false
  • English
  • Français

Does the Canadian Emergency Department Triage and Acuity Scale identify non-urgent patients who can be triaged away from the emergency department?

Published online by Cambridge University Press:  21 May 2015

Les Vertesi
Les Vertesi*
Affiliation:
Fraser Health Authority; Institute for Health Research and Education, Simon Fraser University; Royal Columbian Hospital, New Westminster, BC.
*
Institute for Health Research and Education, Rm. 2820, West Mall Centre, Simon Fraser University, Burnaby BC V5A 1S6; les_vertesi@sfu.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Introduction:

Non-urgent visits comprise a significant proportion of visits to most emergency departments (EDs). Given the severe overcrowding issues faced by many EDs, the use of the Canadian Emergency Department Triage and Acuity Scale (CTAS) to identify patients who could be managed elsewhere seems to be an obvious way to reduce the pressure on the ED and “solve” the overcrowding problem.

Objective:

To quantify the resource implications, in terms of stretcher use and waiting times, related to non-urgent patient visits and to estimate the potential impact on ED flow of redirecting these patients to alternate primary care settings.

Methods:

Retrospective database audit in an urban referral hospital ED. For this study, patients triaged as either CTAS Levels IV or V were considered “non-urgent.”

Results:

Non-urgent patients comprised 30% of ED visits, but less than 5% of all those needing stretchers, along with their associated nursing resources. The longer waits consisted almost entirely of waits for available stretchers and would therefore have remained essentially unaffected. In spite of being labelled “non-urgent” by CTAS criteria, 7.3% of all patients requiring admission came from this group.

Conclusions:

Non-urgent patients consume a small fraction of the ED stretchers and acute-care resources; therefore, strategies aimed at diverting non-urgent patients are unlikely to improve access for more urgent patients. Using the CTAS to identify patients for diversion away from the ED is measurably unsafe and will lead to inappropriate refusal of care for many patients requiring hospital treatment.

Keywords

emergency department overcrowdingCTASCanadian Emergency Department Triage and Acuity Scaleemergency department management
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 337 - 342
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Canadian Association of Emergency Physicians and National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding [policy]. Can J Emerg Med 2001;3(2):82–4.CrossRefGoogle Scholar
2.Canadian Association of Emergency Physicians and the National Emergency Nurses Affiliation. Joint Position Statement. Access to acute care in the setting of emergency department overcrowding [policy]. Can J Emerg Med 2003;5(2):81–6.CrossRefGoogle Scholar
3.Graff, L.Overcrowding in the ED: an international symptom of health care system failure. Am J Emerg Med 1999;17:208–9.Google Scholar
4.Derlet, R, Richards, J, Kravitz, RL.Frequent overcrowding in US emergency departments. Acad Emerg Med 2001;8:151–5.Google Scholar
5.Schull, MJ, Szalai, JP, Schwartz, B, Redelmeier, DA.Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years. Acad Emerg Med 2001;8:1037–43.Google Scholar
6.Decter, MB: Four strong winds: understanding the growing challenges to health care. Toronto (ON): Stoddart Publishing Ltd; 2000.Google Scholar
7.Crowding Resources Task Force, American College of Emergency Physicians. Responding to emergency department crowding: a guidebook for chapters. Dallas (TX): The College; Aug 2002. Available: www.acep.org/1,5238,0.html (accessed 2004 July 27).Google Scholar
8.Derlet, RW, Kinser, D, Ray, L, Hamilton, B, McKenzie, J.Prospective identification and triage of nonemergency patients out of an emergency department: a 5-year study. Ann Emerg Med 1995;25:215–23.Google Scholar
9.Washington, DL, Stevens, CD, Shekelle, PG, Baker, DW, Fink, A, Brook, RH.Safely directing patients to appropriate levels of care: guideline-driven triage in the emergency service. Ann Emerg Med 2000;36:15–22.CrossRefGoogle ScholarPubMed
10.Beveridge, R, Clarke, B, Janes, L, Savage, N, Thompson, J, Dodd, G, et al. Canadian Emergency Department Triage and Acuity Scale: implementation guidelines. Can J Emerg Med 1999;1(3 Suppl). Online version available at: www.caep.ca/002.policies/002–02.ctas.htm (accessed 10 Aug 2004).Google Scholar
11.Jiménez, JG, Murray, MJ, Beveridge, R, Pons Pons, J, Cortés, EA, Ferrando, Garrigós, et al. Implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the Principality of Andorra: Can triage parameters serve as emergency department quality indicators? Can J Emerg Med 2003;5(5): 315–22.Google ScholarPubMed
12.Manos, D, Petrie, DA, Beveridge, RC, Walter, S, Ducharme, J.Interobserver agreement using the Canadian Emergency Department Triage and Acuity Scale. Can J Emerg Med 2002;4(1):16–22.CrossRefGoogle ScholarPubMed
13.Grafstein, E, Innes, G, Westman, J, Christenson, J, Thorne, A.Interrater reliability of a computerized presenting-complaint–linked triage system in an urban emergency department. Can J Emerg Med 2003;5(5):323–9.Google Scholar
14.Gill, JM, Reese, CL 4th, Diamond, JJ.Disagreement among health care professionals about the urgent care needs of emergency department patients. Ann Emerg Med 1996;28:474–9.Google Scholar
15.Young, GP, Wagner, MB, Kellermann, AL, Ellis, J, Bouley, D.Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group. JAMA 1996;276(6):460–5.Google Scholar
16.Schull, MJ, Slaughter, PM, Redelmeier, DA.Urban emergency department overcrowding: defining the problem and eliminating misconceptions. Can J Emerg Med 2002;4(2):76–83.CrossRefGoogle ScholarPubMed
17.Baumann, BM, Chansky, ME, Boudreaux, ED.Holding admitted patients in the emergency department is most highly correlated with longer patient throughput times. Acad Emerg Med 2004; 11:453.Google Scholar
18.Richardson, DB.The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust 2002;177:492–5.Google Scholar
19.Trzeciak, S, Rivers, EP.Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402–5.Google Scholar
20.Bazarian, JJ, Schneider, SM, Newman, VJ, Chodosh, J.Do admitted patients held in the emergency department impact the throughput of treat-and-release patients? Acad Emerg Med 1996;3:1113–8.CrossRefGoogle ScholarPubMed
21.Forster, AJ, Stiell, I, Wells, G, Lee, AJ, van Walraven, C.The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med 2003;10:127–33.CrossRefGoogle ScholarPubMed
22.Dunn, R.Reduced access block causes shorter emergency department waiting times: an historical control observational study. Emerg Med 2003;15:232–8.Google Scholar
23.Estey, A, Ness, K, Saunders, LD, Alibhai, A, Bear, RA.Understanding the causes of overcrowding in emergency departments in the Capital Health Region in Alberta: a focus group study. Can J Emerg Med 2003;5(2):87–94.CrossRefGoogle Scholar
24.Espinosa, G, Miro, O, Sanchez, M.Effects of external and internal factors on emergency department overcrowding. Ann Emerg Med 2002;39:693–5.Google Scholar
25.Schull, M.Emergency department contributors to ambulance diversion: a quantitative analysis Ann Emerg Med 2003;41:467–76.Google Scholar