The Factors and Predictive Models of Hospitalization among Emergency Department Patients Triaged as Low to Moderate Urgency

The development of emergency care system during the past five decades provides great benefits for patients with emergent needs. Due to the growing needs of such emergent care, overcrowding of emergency department becomes a major concern worldwide. The policy makers adopted triage and acuity system to overcome the allocation issues under limited medical resources. An accurate triage system is to prioritize patients with urgent needs for prompt assistance however a patient with less urgent condition is to be served later on. Taiwan has introduced a five acuity triage system, TTAS, to replace the conventional four acuity triage system, TTS, in 2010. Documents have demonstrated superior features regarding efficiency and effectiveness of emergency care under TTAS. However, a certain level of hospitalization rate and death tolls was found among patients with low to moderate urgent acuity levels (levels 4-5 in TTAS). This imperfection of triage system poses potential hazard to quality of emergency care and is warranted for in-depth studies. This study is a retrospective follow up design in which chief complaint specific prediction models of hospitalization will be constructed among low to moderate urgent patients. The settings of this analysis will be set to a medical center, one of the hospitals with the highest emergency visits volume in Taiwan. The study will classify the factors related to hospitalization into pre-hospital, upon triage in emergency department, and post-triage in emergency department. The information included in this study will be classified as patient’s basic demographics, underlying diseases, triage level, vital signs, delivery mode, examinations and treatments, and claim data of post- emergency department hospitalization. The objectives of this study are as follows: 1) To characterize the subsequent hospitalization patients with low to moderate urgency in emergency department. 2) To construct chief complaint specific predictive models for hospitalization among patients with low to moderate urgency in emergency department. 3) To modify current practice flow derived from the chief complaint specific predictive models and to validate the models with empirically prospective data. The findings of this study will affect the current practice of low to moderate urgent patients and provide solutions for future clinical decision rules in emergency care. The value of this analysis will be placed in improving the efficiency and effectiveness of emergency care under TTAS in practical and lined in innovative theoretical exigencies of future amendments for triage systems in emergency department.

Project ID:PF10301-0611
External Project ID:NSC102-2410-H182-010-MY2