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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: [email protected]
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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 

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