Optimizing triage and hospitalization in adult general medical emergency patients: the triage project

Philipp Schuetz, Pierre Hausfater, Devendra Amin, Sebastian Haubitz, Lukas Fässler, Eva Grolimund, Alexander Kutz, Ursula Schild, Zeljka Caldara, Katharina Regez, Andriy Zhydkov, Timo Kahles, Krassen Nedeltchev, Stefanie von Felten, Sabina De Geest, Antoinette Conca, Petra Schäfer-Keller, Andreas Huber, Mario Bargetzi, Ulrich Buergi, Gabrielle Sauvin, Pasqualina Perrig-Chiello, Barbara Reutlinger, Beat Mueller

Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site-of-care decisions and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced into clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at the most proximal time point of ED admission.