Young Sun Ro1, Sang Do Shin2, Kyoung Jun Song2, Won Chul Cha3, Jin Sung Cho4. 1. Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. 2. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea. 4. Department of Emergency Medicine, Gachon University Gil Hospital, Gyeonggi, Korea.
Abstract
OBJECTIVE: The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment (TRACT) protocol and mortality and length of stay (LOS) in ED. METHODS: This before-and-after study was conducted in an adult, tertiary, teaching hospital ED from August 2008 to July 2012. Patients who were younger than 18 years of age, who were dead on arrival and whose triage information was not available were excluded. TRACT was implemented in August 2010, and the Emergency Severity Index (ESI) was used for triage. Primary and secondary outcomes were ED mortality and ED LOS. Multivariate logistic regression models for ED mortality and multivariable general linear models on the ED LOS were used to compare the before- and after-intervention periods. RESULTS: For the 155 563 visits over study period, the ED mortality rate was 0.2%, and the ED LOS was 4.6 h (median). The adjusted odds ratios (95% confidence intervals [CIs]) of the TRACT protocol on ED mortality were 0.69 (0.54-0.88) for total patients, 0.42 (0.30-0.59) for ESI 1, 1.04 (0.66-1.65) for ESI 2 and 1.45 (0.76-2.75) for ESI 3 group. The adjusted coefficients (95% CIs) of the TRACT on the ED LOS were -88.1 (-96.9 ∼ -79.2) min for all patients, -44.9 (-72.0 ∼ -17.9) min for ESI level 2 and -104.3 (-114.7 ∼ -94.0) min for ESI level 3. CONCLUSIONS: The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups.
OBJECTIVE: The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment (TRACT) protocol and mortality and length of stay (LOS) in ED. METHODS: This before-and-after study was conducted in an adult, tertiary, teaching hospital ED from August 2008 to July 2012. Patients who were younger than 18 years of age, who were dead on arrival and whose triage information was not available were excluded. TRACT was implemented in August 2010, and the Emergency Severity Index (ESI) was used for triage. Primary and secondary outcomes were ED mortality and ED LOS. Multivariate logistic regression models for ED mortality and multivariable general linear models on the ED LOS were used to compare the before- and after-intervention periods. RESULTS: For the 155 563 visits over study period, the ED mortality rate was 0.2%, and the ED LOS was 4.6 h (median). The adjusted odds ratios (95% confidence intervals [CIs]) of the TRACT protocol on ED mortality were 0.69 (0.54-0.88) for total patients, 0.42 (0.30-0.59) for ESI 1, 1.04 (0.66-1.65) for ESI 2 and 1.45 (0.76-2.75) for ESI 3 group. The adjusted coefficients (95% CIs) of the TRACT on the ED LOS were -88.1 (-96.9 ∼ -79.2) min for all patients, -44.9 (-72.0 ∼ -17.9) min for ESI level 2 and -104.3 (-114.7 ∼ -94.0) min for ESI level 3. CONCLUSIONS: The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups.
Authors: Yihan Chen; Inderpreet Saini; Shivani K Patel; Holly Wilhalme; William D Miller; Roswell Quinn Journal: J Gen Intern Med Date: 2019-10 Impact factor: 5.128
Authors: Marta Fernandes; Rúben Mendes; Susana M Vieira; Francisca Leite; Carlos Palos; Alistair Johnson; Stan Finkelstein; Steven Horng; Leo Anthony Celi Journal: PLoS One Date: 2020-04-02 Impact factor: 3.240