Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T12:38:55.697Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident

Published online by Cambridge University Press:  24 June 2015

James S. Lee  and
Jeffrey M. Franc
James S. Lee*
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
Jeffrey M. Franc
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Anesthesia and Intensive Care, Università degli Studi del Piemonte Orientale “Amedeo Avogadro,”Novara, Italy
*
Correspondence: James Lee, MD Department of Emergency Medicine University of Alberta 750 University Terrace, 8303 112 Street Edmonton, Alberta, Canada T6G 2T4 E-mail: james.lee@ualberta.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

A high influx of patients during a mass-casualty incident (MCI) may disrupt patient flow in an already overcrowded emergency department (ED) that is functioning beyond its operating capacity. This pilot study examined the impact of a two-step ED triage model using Simple Triage and Rapid Treatment (START) for pre-triage, followed by triage with the Canadian Triage and Acuity Scale (CTAS), on patient flow during a MCI simulation exercise.

Hypothesis/Problem

It was hypothesized that there would be no difference in time intervals nor patient volumes at each patient-flow milestone.

Methods

Physicians and nurses participated in a computer-based tabletop disaster simulation exercise. Physicians were randomized into the intervention group using START, then CTAS, or the control group using START alone. Patient-flow milestones including time intervals and patient volumes from ED arrival to triage, ED arrival to bed assignment, ED arrival to physician assessment, and ED arrival to disposition decision were compared. Triage accuracy was compared for secondary purposes.

Results

There were no significant differences in the time interval from ED arrival to triage (mean difference 108 seconds; 95% CI, -353 to 596 seconds; P=1.0), ED arrival to bed assignment (mean difference 362 seconds; 95% CI, -1,269 to 545 seconds; P=1.0), ED arrival to physician assessment (mean difference 31 seconds; 95% CI, -1,104 to 348 seconds; P=0.92), and ED arrival to disposition decision (mean difference 175 seconds; 95% CI, -1,650 to 1,300 seconds; P=1.0) between the two groups. There were no significant differences in the volume of patients to be triaged (32% vs 34%; 95% CI for the difference -16% to 21%; P=1.0), assigned a bed (16% vs 21%; 95% CI for the difference -11% to 20%; P=1.0), assessed by a physician (20% vs 22%; 95% CI for the difference -14% to 19%; P=1.0), and with a disposition decision (20% vs 9%; 95% CI for the difference -25% to 4%; P=.34) between the two groups. The accuracy of triage was similar in both groups (57% vs 70%; 95% CI for the difference -15% to 41%; P=.46).

Conclusion

Experienced triage nurses were able to apply CTAS effectively during a MCI simulation exercise. A two-step ED triage model using START, then CTAS, had similar patient flow and triage accuracy when compared to START alone.

LeeJS, FrancJM. Impact of a Two-step Emergency Department Triage Model with START, then CTAS, on Patient Flow During a Simulated Mass-casualty Incident. Prehosp Disaster Med. 2015;30(4):1–7.

Keywords

CTASmass-casualty incidentMCISTARTtriagetwo-step triage
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 30 , Supplement 4 , August 2015 , pp. 390 - 396
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Pesik, N, Keim, ME, Iserson, K. Terrorism and the ethics of emergency medical care. Ann of Emerg Med. 2001;37(6):642-646.CrossRefGoogle ScholarPubMed
2. Beveridge, R, Clarke, B, Janes, L, et al. Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM. 1999;1(suppl):S2-S8.Google Scholar
3. Bullard, MJ, Unger, B, Spence, J, Grafstein, E. Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CJEM. 2008;10(2):136-142.CrossRefGoogle Scholar
4. Super, G. START: a training module. Newport Beach, California USA: Hoag Memorial Hospital Presbyterian; 1984.Google Scholar
5. Holroyd, BR, Bullard, MJ, Latoszek, K, et al. Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trail. Acad Emerg Med. 2007;14(8):702-708.Google Scholar
6. Aylwin, CJ, Konig, TC, Brennan, NW, et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet. 2006;368(9554):2218-2225.CrossRefGoogle Scholar
7. Benson, M, Koenig, K, Schultz, C. Disaster triage: START, then SAVE – a new method of dynamic triage for victims of a catastrophic earthquake. Prehosp Disaster Med. 1996;11(2):117-124.Google Scholar
8. Carley, S, Mackway-Jones, K. Major Incident Medical Management and Support: The Practical Approach in the Hospital. Oxford, UK: Blackwell Publishing Ltd; 2005.Google Scholar
9. Franc-Law, JM, Bullard, M, Della Corte, F. Simulation of a hospital disaster plan: a virtual, live exercise. Prehosp Disaster Med. 2008;23(4):346-352.Google Scholar
10. Franc-Law, JM, Ingrassia, PL, Ragazoni, L, Della Cort, F. The effectiveness of training with an emergency department simulator on medical student performance in a simulated disaster. CJEM. 2010;12(1):27-32.CrossRefGoogle Scholar
11. ICED Incident Command Emergency Department Disaster Plan. http://www.medstatstudio.com/studies/iced_0_0_9.pdf. Accessed June 17, 2014.Google Scholar
12. CTAS App. https://itunes.apple.com/ca/app/ctas-official-version-english/id595920336?mt=8. Accessed June 17, 2014.Google Scholar
13. Dong, SL, Bullard, MJ, Meurer, DP, et al. Reliability of computerized emergency triage. Acad Emerg Med. 2006;13(3):269-275.Google Scholar
14. Dong, SL, Bullard, MJ, Meurer, DP, et al. Predictive validity of a computerized emergency triage tool. Acad Emerg Med. 2007;14(1):16-21.CrossRefGoogle ScholarPubMed
15. Montgomery, DC, Peck, EA, Vining, GG. Introduction to Linear Regression Analysis, 4th Edition. New York City: New York USA: Wiley-Interscience; 2006.Google Scholar
16. Kahn, CA, Schultz, CH, Miller, KT, Anderson, CL. Does the START triage work? An outcome assessment after a disaster. Ann Emerg Med. 2009;54(3):424-430.Google Scholar
Supplementary material: Image

Lee and Franc supplementary material

Lee and Franc supplementary material 1

Download Lee and Franc supplementary material(Image)
Image 4.3 MB
Supplementary material: Image

Lee and Franc supplementary material

Lee and Franc supplementary material 2

Download Lee and Franc supplementary material(Image)
Image 4.3 MB