Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group
Gabriele Savioli,
Iride Francesca Ceresa,
Maria Antonietta Bressan,
Gaia Bavestrello Piccini,
Angelica Varesi,
Viola Novelli,
Alba Muzzi,
Sara Cutti,
Giovanni Ricevuti,
Ciro Esposito,
Antonio Voza,
Antonio Desai,
Yaroslava Longhitano,
Angela Saviano,
Andrea Piccioni,
Fabio Piccolella,
Abdel Bellou,
Christian Zanza,
Enrico Oddone
Affiliations
Gabriele Savioli
Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
Iride Francesca Ceresa
Department of Emergency, Ospedale Civile, 27029 Vigevano, Italy
Maria Antonietta Bressan
Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
Gaia Bavestrello Piccini
Faculty of Medicine, University of Pavia, 27100 Pavia, Italy
Angelica Varesi
Faculty of Medicine, University of Pavia, 27100 Pavia, Italy
Viola Novelli
Health Department, University of Pavia, 27100 Pavia, Italy
Alba Muzzi
Health Department, University of Pavia, 27100 Pavia, Italy
Sara Cutti
Health Department, University of Pavia, 27100 Pavia, Italy
Giovanni Ricevuti
Department of Drug Science, University of Pavia, 27100 Pavia, Italy
Ciro Esposito
Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
Antonio Voza
Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy
Antonio Desai
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
Yaroslava Longhitano
Department of Anesthesiology and Intensive Care Medicine—AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
Department of Anesthesiology and Intensive Care Medicine—AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
Abdel Bellou
Institute of Sciences in Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
Christian Zanza
Department of Anesthesiology and Intensive Care Medicine—AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
Enrico Oddone
Department of Public Health, Experimental and Forensic Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.
