Improved Triage Accuracy: The Clinical Benefits

Rapid risk stratification of getriatric patients with non-specific complaints

The combination of MR-proADM and ITT: More accurate patient risk assessment and stratification

Enhanced patient reclassificationEnhanced patient reclassification

A total of 34 % of patients (n=169) could be reclassified using the combination of MR-proADM and ITT, leading to the conclusion that over a third of patients were inaccurately or inappropriately classified using ET decisions alone. Indeed, inaccurate patient classification on initial triage can lead to factors such as increased time to treatment, additional adverse effects and elevated healthcare resource consumption, resulting in an overall decrease in patient safety28, 29.

 

Decreased acute ward and higher intensity admissionsDecreased acute ward and higher intensity admissions

The combination of MR-proADM and ITT resulted in an additional 24.1 % of patients (n=120) being moved to a lower risk category, compared to the use of ET scores alone, thus saving on essential resources and freeing up valuable spaces for patients with more severe morbidities. Furthermore, 9.7 % fewer patients could be classified as the highest potential risk - a decrease from 58.4 % to 48.7 % - representing a reduction of 17 % in absolute numbers.

 

Increased out-patient numbersIncreased out-patient numbers

Using the MR-proADM and ITT algorithm, out-patient numbers could be increased by 8.2 % - from an initial 13.3 % using ET scores alone, to a revised 21.5 % - representing an increase of 62 % in absolute numbers, and a corresponding decrease in patient mortality of 0.6 %. Not only has the combination of MR-proADM and ITT been shown to be both effective and safe, but increased out-patient care can consequently provide greater patient satisfaction and comfort, enhanced cost effectiveness, and decreased healthcare resource consumption30.

 

Increased patient safetyIncreased patient safety

An additional 9.9 % of patients (n=49) using the MR-proADM and ITT algorithm were found to have a more severe underlying condition than observed using ET alone, and were consequently moved to a higher risk category. The under-triage of geriatric patients has been previously shown to constitute a significant problem in the ED, with more than twice as many cases being observed compared to in patients aged 55 years or less31, 32.

Arrow Water

The combination of ITT and MR-proADM, therefore, can provide the treating ED physician with a rapid and accurate risk assessment of the patient’s health with which to base their final disposition decision on, thus maximizing patient safety, and in the process reducing overall ED admissions and increasing the safe discharge of patients.

 

MR-proADM: The essential risk assessment tool for non-specific complaints

The addition of MR-proADM values to the initial ITT score significantly improves the accuracy of stratifying patients with severe underlying conditions, from those that are less urgent.

However, it has also been shown that the independent use of MR-proADM results in a more accurate assessment of the severity of the underlying illness, and consequently the overall risk to the patient, compared to either ITT or ET decisions (C-index of 0.732 for MR-proADM alone, compared to 0.649 for ITT and 0.662 for ET decisions).

Nevertheless, an increase from an initial ITT C-index score of 0.649 to 0.734 when both ITT and MR-proADM values were combined indicates a more precise risk stratification, which may have major implications for future patient care and hospital resource allocation.

Furthermore, when MR-proADM scores were supplemented by age and sex, accuracy was increased above and beyond that of ITT + MR-proADM. Values were shown to increase from an ITT C-index score of 0.649 to a revised score of 0.742. Informed physician expertise and experience when risk stratifying patients, however, is invaluable, and should always form the basis for subsequent patient disposition.

C-index comparison between ITT, ET, MR-proADM, ITT + MR-proADMC-index comparison between ITT, ET, MR-proADM, ITT + MR-proADM and MR-proADM including age and sex variables, highlights the use of MR-proADM in more accurately assessing and stratifying patient risk.

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