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P063: Is triage score a valid measure of emergency department case mix?

Published online by Cambridge University Press:  02 June 2016

B.R. Holroyd
Affiliation:
University of Alberta, Edmonton, AB
R.J. Rosychuk
Affiliation:
University of Alberta, Edmonton, AB
S. Jelinski
Affiliation:
University of Alberta, Edmonton, AB
M. Bullard
Affiliation:
University of Alberta, Edmonton, AB
C. McCabe
Affiliation:
University of Alberta, Edmonton, AB
B.H. Rowe
Affiliation:
University of Alberta, Edmonton, AB
G. Innes
Affiliation:
University of Alberta, Edmonton, AB
S. Niu
Affiliation:
University of Alberta, Edmonton, AB
S. Dean
Affiliation:
University of Alberta, Edmonton, AB

Abstract

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Introduction: In the Canadian province of Alberta, (pop. 4,227,879), the publicly-funded health care system uses the five level Canadian Triage and Acuity Scale (CTAS), to prioritize emergency department (ED) patients. Health system decision makers and policy makers currently use CTAS as an isolated metric to describe ED patient case-mix and to compare EDs. Methods: Using the National Ambulatory Care Reporting System dataset, we reviewed the distribution of patient CTAS scores and the proportion of inpatient admissions by CTAS level for the 16 highest volume Alberta hospital EDs during FY 2013/2014. Results: Collectively, the EDs received 1,027,976 patients, with 1%, 18%, 44%, 30% and 7% classified as CTAS 1-5, respectively. The proportions by CTAS level ranged from 0.2% to 2.8% in CTAS 1; 3.3% to 33.3% in CTAS 2; 29.1% to 54.1% in CTAS 3; 16.7% to 49.0% in CTAS 4; and 3.1% to 12.3% in CTAS 5. Admission proportions by CTAS level ranged from 43.9% to 75.2% in CTAS 1; 18.9% to 42.1% in CTAS 2; 5.4% to 24.7% in CTAS 3; 0.8% to 9.3% in CTAS 4; and 0.1% to 9.1% in CTAS 5. Conclusion: Inter-hospital differences in CTAS acuity distributions reflect triage variability and real differences in case-mix. Wide variation in admission proportions by CTAS level reflects differing admission thresholds between sites, but also suggest intra-level differences in patient severity, comorbidity and complexity. Triage levels cannot be used as an isolated metric to describe and compare ED case-mix. Further work is required to accurately characterize ED patient case-mix.

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Copyright
Copyright © Canadian Association of Emergency Physicians 2016