ePosters: Health Policy and Health Services Research, Patient Safety and Quality
692 - Comparison of Physician Acuity Assessment With Emergency Severity Index and Canadian Triage and Acuity Scales
Thursday, May 14, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Triage, performed by a nurse, to determine acuity is the first step in Emergency Department (ED) patient evaluation. Two common triage scales are: Canadian Triage and Acuity Scale (CTAS) and Emergency Severity Index (ESI). CTAS uses critical look, chief complaint, and vital signs (VS). ESI uses VS, whether life or limb threat, and resources. There has not been a comparison of CTAS or ESI with physician patient assessment. Hypothesis: Is there is a difference between admitted and discharged patients for the three scales and does physician assessment agree with CTAS and ESI?
Methods: ED physicians were queried regarding the acuity of patients on 5 point Likert scale: Level 1 Critical: immediate care required, Level 2 Emergent: care required within 15 minutes, Level 3 Urgent: care required within 15 - 60 minutes, Level 4 Semi-urgent: care required within 2 - 24 hours, Level 5 Non-urgent: care required within several days. This was compared with CTAS and ESI. Both CTAS and ESI are also a 1-5 scale with 1 being the highest acuity and 5 the lowest acuity. Statistical significance was p < 0.05 using t-test. Patient population was a convenience sample of adult (≥ 18 years) ED, non-critical, non-pregnant, non-psychiatric, English speaking patients who provided informed consent and were prospectively surveyed at an urban, tertiary level ED (n = 348) and a suburban, free-standing ED (n = 204).
Results: On all three scales, admitted patients had a significantly higher acuity than discharged patients ( p < 0.001). Admitted (n = 128): physician 2.98 (±0.93), CTAS 2.82 (±0.79), ESI 2.71 (±0.64). Discharged (n = 424): physician 3.91 (±0.84), CTAS 4.02 (±0.70), ESI 3.63 (±0.67). All patients (n = 552): physician 3.69 (±0.94), CTAS 3.74 (±0.88), ESI 3.42 (±0.77). There was no significant difference between physician acuity and CTAS, except for discharged patients (p = 0.033). Physician assessment predicted significantly lower acuities (higher scores) than ESI for all three patient groups (p <0.01).
Conclusion: On all three scales, admitted patients had a significantly higher acuity than discharged patients. Physician gestalt is as good as ESI and CTAS scales in predicting which patients have the highest acuity and need to be admitted. Physician assessment and CTAS had better agreement than ESI. ESI had the lowest scores compared to physician gestalt and CTAS. This is likely because ESI includes resources.