Shelley L McLeod1,2,3, Keerat Grewal4, Cameron Thompson4, Lehana Thabane5, Bjug Borgundvaag4,6, Howard Ovens4,6, Steve Scott7, Tamer Ahmed7, Nicole Mittmann7,8, Andrew Worster5,9, Thomas Agoritsas5,10, Gordon Guyatt5,11. 1. Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada. shelley.mcleod@sinaihealth.ca. 2. Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, 600 University Avenue Room 206, Toronto, ON, M5G 1X5, Canada. shelley.mcleod@sinaihealth.ca. 3. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. shelley.mcleod@sinaihealth.ca. 4. Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada. 5. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 6. Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, 600 University Avenue Room 206, Toronto, ON, M5G 1X5, Canada. 7. Ontario Health (Cancer Care Ontario), Ministry of Health, Toronto, ON, Canada. 8. Sunnybrook Research Institute, Toronto, ON, Canada. 9. Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada. 10. Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland. 11. Department of Medicine, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVE: To explore the impact of the implementation of eCTAS, a real-time electronic decision-support tool, on hospital admission, rate of left without being seen, and time from triage to physician initial assessment. METHODS: We conducted a cohort study using population-based administrative data from all Ontario emergency departments (EDs) that had implemented eCTAS for 9 months. We compared 6 months post-eCTAS data to the same 6 months the previous year (pre-eCTAS). We included triage encounters of adult (≥ 18 years) patients if they had one of 16 pre-specified, high-volume presenting complaints. Multivariable logistic regression and quantile regression models informed the effect of eCTAS on outcomes. RESULTS: We included data from 354,176 triage encounters from 31 EDs. There was a change in the distribution of triage scores post-eCTAS, with fewer patients classified as CTAS 2 and CTAS 3, and more patients classified as CTAS 1 and CTAS 4. Overall, hospital admission decreased post-eCTAS (adjusted OR: 0.98; 95% CI: 0.97 to 1.00), with fewer CTAS 2 and more CTAS 3 and CTAS 4 patients admitted post-eCTAS. The rate of left without being seen increased (2.8% vs. 3.0%; adjusted OR: 1.07; 95% CI: 1.03 to 1.11) post-eCTAS, while time to physician initial assessment proved similar pre and post-eCTAS. CONCLUSIONS: eCTAS implementation had little impact on admission, rate of left without being seen and time to physician initial assessment. eCTAS appears to reclassify patients from higher to lower acuity scores, resulting in higher admission rates for CTAS 3 and CTAS 4 patients. It remains unknown if this reclassification is appropriate.
OBJECTIVE: To explore the impact of the implementation of eCTAS, a real-time electronic decision-support tool, on hospital admission, rate of left without being seen, and time from triage to physician initial assessment. METHODS: We conducted a cohort study using population-based administrative data from all Ontario emergency departments (EDs) that had implemented eCTAS for 9 months. We compared 6 months post-eCTAS data to the same 6 months the previous year (pre-eCTAS). We included triage encounters of adult (≥ 18 years) patients if they had one of 16 pre-specified, high-volume presenting complaints. Multivariable logistic regression and quantile regression models informed the effect of eCTAS on outcomes. RESULTS: We included data from 354,176 triage encounters from 31 EDs. There was a change in the distribution of triage scores post-eCTAS, with fewer patients classified as CTAS 2 and CTAS 3, and more patients classified as CTAS 1 and CTAS 4. Overall, hospital admission decreased post-eCTAS (adjusted OR: 0.98; 95% CI: 0.97 to 1.00), with fewer CTAS 2 and more CTAS 3 and CTAS 4 patients admitted post-eCTAS. The rate of left without being seen increased (2.8% vs. 3.0%; adjusted OR: 1.07; 95% CI: 1.03 to 1.11) post-eCTAS, while time to physician initial assessment proved similar pre and post-eCTAS. CONCLUSIONS: eCTAS implementation had little impact on admission, rate of left without being seen and time to physician initial assessment. eCTAS appears to reclassify patients from higher to lower acuity scores, resulting in higher admission rates for CTAS 3 and CTAS 4 patients. It remains unknown if this reclassification is appropriate.
Authors: Shelley L McLeod; Cameron Thompson; Bjug Borgundvaag; Lehana Thabane; Howard Ovens; Steve Scott; Tamer Ahmed; Keerat Grewal; Joy McCarron; Brooke Filsinger; Nicole Mittmann; Andrew Worster; Thomas Agoritsas; Michael Bullard; Gordon Guyatt Journal: J Am Coll Emerg Physicians Open Date: 2020-04-21
Authors: Seung Wook Kim; Yong Won Kim; Yong Hun Min; Kui Ja Lee; Hyo Ju Choi; Dong Won Kim; You Hwan Jo; Dong Keon Lee Journal: Yonsei Med J Date: 2022-03 Impact factor: 2.759