The Study of Chief Complaint Specific Emergency Triage System among Elderly Patients—Acuity Validation, Modifiers, and Model Construction.

Overcrowding of emergency department is a global issue of health care management. Particularly, the overcrowding impacts are even noteworthy in the emergency department of medical centers in Taiwan. Therefore, an accurate triage system to prioritize patients with urgent needs for prompt assistance is vital for emergency care. Documents have demonstrated superior efficiency and effectiveness of emergency care under Taiwan Triage and Acuity System (TTAS). However, improvements were found to be necessary to ensure justice of medical assistance and patient safety. Moreover, a timely and appropriate emergency care is also important to improve care quality while containing medical consumptions. The elderly patients in emergency department are physiologically heterogeneous and developmentally complicated of which may confound the triage of their urgency. The revision of current triage system is warranted for the elderly patients in emergency department. This study is a retrospective data on the elderly patients aged over 65 years in the emergency department of a medical center located in north Taiwan. The study will use the elderly patients admitted during 2012-2014 as the primary samples to explore modifiers for the elderly triage system while taking the database in 2015 as the prospective validation samples. The number of elderly patients will be 45,208, 35,012, and 17,358 in three age groups including 65-74.9, 75-84.9, and ＞=85, respectively. The study will explore modifiers of the triage system according to top ten chief complaints of the elderly patients in the emergency department. Multiple logistic regression will be applied to analyze candidate modifiers classified into vital signs, administrative characteristics, and physician’s assessments. The objectives of this study are as follows: 1) To examine the appropriateness and leverage of the TTAS among the elderly patients in emergency department. 2) To explore the modifiers of the TTAS among the elderly patients in emergency department. 3) To construct and validate the chief complaint specific predictive models among the elderly patients in emergency department. The findings of modifiers suitable to reshuffle the TTAS for the elderly patients in this study will affect the practice of emergency department patient’s clinical decisions in emergency care. An accurate triage system on the elderly emergency department patients may mean a high efficiency of emergency management and a better medical quality in emergency medicine. The value of this study will contribute both academically and practically in future care of geriatric medicine and emergency medicine.

Project ID:PF10607-1679
External Project ID:MOST106-2410-H182-020