ED Triage and MR-proADM

Rapid risk stratification of getriatric patients with non-specific complaints

Current risk assessment methods result in unnecessary acute ward admissions

The ability to make safe, rapid and accurate decisions regarding patient disposition (i.e. out-patient treatment or admission to a geriatric or acute ward) is crucial given the rapid workflow within an emergency department.

Upon admission, a preliminary disposition plan is constructed after an initial patient assessment, work-up and diagnostic testing, and is known as the intention to transfer (ITT). A final disposition plan, known as the effective transfer (ET) is made after a period of prolonged patient observation, such as an overnight stay19, when in-patient beds become available. Consequently, both ITT and ET decisions require a significant degree of healthcare resource consumption, such as physician time, diagnostic testing and an observation area.

It is therefore surprising that the accuracy of determining the severity of the underlying condition, and the consequent risk to the patient, using either ITT or ET, is relatively low.

Indeed, both ITT and ET C-index scores for 30 day, NSC survival show only moderate clinical accuracy in correctly determining those patients at risk (0.649 and 0.662 respectively)19. In addition, a clear tendency has been shown to admit more patients to the highest level of care than is actually required (+18 %) after ET decisions, presumably for safety reasons19. This can therefore result in a lack of available resources for patients most in need, as well as placing the clinical setting in question under unnecessary financial pressure.

The ability to accurately determine the severity of the underlying condition, and the consequent risk to the patient’s health, is not fulfilled by the use of ITT or ET decisions alone, to the detriment of both the patient and the healthcare provider.

Current risk assessment methodsAfter a period of prolonged observation (ET), more patients were admitted to the highest level of care than was originally planned (ITT) upon admission19, however, risk assessment accuracy was not significantly altered, remaining at moderate levels only (ITT: 0.649, ET: 0.662)

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