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Improved pediatric patient flow in a general emergency department by altering triage criteria
1Department of Emergency Medicine, Louisiana State University Medical Center, Baton Rouge, LA, USA.
Insights
Altering pediatric triage criteria significantly improved emergency department (ED) patient flow. More children were correctly identified as emergent or urgent, leading to faster treatment and admission times.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Operations
- Clinical Triage Systems
Background:
- Pediatric emergency department (ED) patient flow is often suboptimal.
- Current triage criteria may not accurately reflect the acuity of pediatric patients.
- Efficient triage is crucial for timely and appropriate patient care.
Purpose of the Study:
- To assess the impact of modified pediatric triage criteria on ED triage scoring.
- To evaluate the effect of these changes on overall pediatric patient flow within the ED.
Main Methods:
- A prospective observational study was conducted over six months in an urban general ED.
- Pediatric triage criteria were modified after three months by increasing the acuity of certain historical items and specifying abnormal signs/symptoms.
- Data collected included triage scores, emergent criteria, triage category proportions, and times to examination, disposition, and admission.
Main Results:
- Modified triage criteria led to a significant increase in emergent (2% to 15%) and urgent (48% to 55%) triage assignments.
- Mean times to ED examination, floor admission, and ICU admission significantly decreased for emergent and urgent patients.
- Key factors influencing these improvements included a history of color change, decreased activity, and prematurity with complications.
Conclusions:
- Revised pediatric triage criteria, incorporating age-specific abnormal signs and symptoms and elevated acuity for specific historical clues, significantly improved pediatric patient flow.
- These modifications enhance the accuracy of triage scoring and expedite patient management in the ED.
Objective:
To evaluate the effect of altering pediatric triage criteria on ED triage scoring and patient flow.
Methods:
A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six-month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission.
Results:
Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications.
Conclusions:
A significant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues.