Examining the relationship between triage acuity and frailty to inform the care of older emergency department patients: Findings from a large Canadian multisite cohort study

ABSTRACTBackgroundThe 2016 Canadian Triage and Acuity Scale (CTAS) updates introduced frailty screening within triage to more accurately code frail patients who may deteriorate waiting for care. The relationship between triage acuity and frailty is not well understood, but may help inform which supplemental geriatric assessments are beneficial to support care in the emergency department (ED). Our objectives were to investigate the relationship between triage acuity and frailty, and to compare their associations with a series of patient outcomes.MethodsWe conducted a secondary analysis of the Canadian cohort from a multinational prospective study. Data were collected on ED patients 75 years of age and older from eight ED sites across Canada between November 2009 and April 2012. Triage acuity was assigned using the CTAS, whereas frailty was measured using an ED frailty index. Spearman rank and binary logistic regression were used to examine associations.ResultsA total of 2,153 ED patients were analyzed. No association was found between the CTAS and ED frailty index scores assigned to patients (r = .001; p = 0.99). The ED frailty index was associated with hospital admission (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.4–1.6), hospital length of stay (OR = 1.4; 95% CI = 1.2–1.6), future hospitalization (OR = 1.1; 95% CI = 1.05–1.2), and ED recidivism (OR = 1.1; 95% CI = 1.04–1.2). The CTAS was associated with hospital admission (e.g., CTAS 2 v. 5; OR = 6; 95% CI = 3.3–11.4).ConclusionOur findings demonstrate that frailty and triage acuity are independent but complementary measures. EDs may benefit from comprehensive frailty screening post-triage, as frailty and its associated geriatric syndromes drive outcomes separate from traditional measures of acuity.

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Predicting Appropriate Hospital Admission of Emergency Department Patients with Bronchiolitis: Secondary Analysis

JMIR Medical Informatics ◽

10.2196/12591 ◽

2019 ◽

Vol 7 (1) ◽

pp. e12591 ◽

Cited By ~ 1

Author(s):

Gang Luo ◽

Bryan L Stone ◽

Flory L Nkoy ◽

Shan He ◽

Michael D Johnson

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Secondary Analysis ◽

Emergency Department Patients

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Age Is Not Associated with Increased Admission Rates, Hospital Length-of-Stay, or Mortality in Elderly Emergency Department Patients Presenting with Undifferentiated Abdominal Pain

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2005.06.432 ◽

2005 ◽

Vol 46 (3) ◽

pp. 118

Author(s):

D.C. Lee ◽

J. Chu ◽

T.C. Bania ◽

D.T. Elliott ◽

P. Eric ◽

...

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Length Of Stay ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Admission Rates ◽

Emergency Department Patients

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Appropriateness of Hospital Admission for Emergency Department Patients with Bronchiolitis: Secondary Analysis

JMIR Medical Informatics ◽

10.2196/10498 ◽

2018 ◽

Vol 6 (4) ◽

pp. e10498 ◽

Cited By ~ 1

Author(s):

Gang Luo ◽

Michael D Johnson ◽

Flory L Nkoy ◽

Shan He ◽

Bryan L Stone

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Secondary Analysis ◽

Emergency Department Patients

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Prevalence of Hospital Admissions for Low Back Pain: Protocol for a Systematic Review and Meta-Analysis

10.31219/osf.io/ym9ka ◽

2020 ◽

Author(s):

Harrison J Lord ◽

Danielle Coombs ◽

Christopher Maher ◽

Gustavo C Machado

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Length Of Stay ◽

Hospital Admission ◽

Hospital Admissions ◽

Functional Decline ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Low Back

Low back pain is the leading cause of years lived with disability in most countries and creates a huge burden for healthcare systems globally. Around the globe, 4.4% of all emergency department attendances are attributed to low back pain, and subsequent admissions to hospital seem to be common. These hospitalisations can result in unnecessary medical care, functional decline and high costs. There are no systematic reviews summarising the global prevalence of hospital admission for low back pain, identifying the sources of admissions or estimating hospital length of stay. This information would be valuable for health and medical researchers, front-line clinicians, and health planners aiming to improve and increase the value of their health services. The objectives of this study are to estimate the prevalence of hospital admission for low back pain from different healthcare facilities across the globe, including the emergency department, as well as investigate hospital length of stay and explore sources of heterogeneity when categorising studies according to low back pain definitions, sources of admission, study period, study setting and country’s region and income level.

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MP37: Emergency department boarding of admitted oncology patients receiving chemotherapy

CJEM ◽

10.1017/cem.2020.185 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S55-S56

Author(s):

K. Grewal ◽

S. McLeod ◽

R. Sutradhar ◽

M. Krzyzanowska ◽

B. Borgundvaag ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Hospital Admission ◽

Cancer Patients ◽

Hospital Length ◽

Primary Objective ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Administrative Databases ◽

Ed Crowding

Introduction: Emergency department (ED) boarding is associated with worse outcomes for critically ill patients. There have been mixed findings in other patient populations. The primary objective of this study was to examine predictors of prolonged ED boarding among cancer patients receiving chemotherapy who required hospital admission from the ED. Secondary objectives were to examine the association between prolonged ED boarding and in-hospital mortality, 30-day mortality, and hospital length of stay (LOS). Methods: Using administrative databases from Ontario, we identified adult (≥ 18 years) cancer patients who received chemotherapy within 30 days prior to a hospital admission from the ED between 2013 to 2017. ED boarding time was calculated as the time from the decision to admit the patient to when the patient physically left the ED. Prolonged ED boarding was defined as ≥ 8 hours. Multivariable logistic regression was used to examine predictors of prolonged ED boarding and to determine if prolonged boarding was associated with mortality. Multivariable quantile regression was used to determine the association between prolonged boarding and hospital LOS. Results: 45,879 patients were included in the study. Median (interquartile range (IQR)) ED LOS of stay was 11.8 (7.0, 21.7) hours and median (IQR) ED boarding time was 4.2 (1.6, 14.2) hours. 17,053 (37.2%) patients had prolonged ED boarding. Severe ED crowding was the strongest predictor of prolonged ED boarding (odds ratio: 17.7, 95% CI: 15.0 to 20.9). Prolonged ED boarding was not associated with in-hospital mortality or 30-day mortality. Median hospital LOS was over 9 hours (p <0.0001) longer among patients with the longest ED boarding times. Conclusion: Severe ED crowding was associated with a significant increase in the odds of prolonged ED boarding. While our study demonstrated that prolonged boarding was not associated with increased mortality, further work is required to understand if ED boarding is associated with other adverse outcomes in this immunocompromised population.

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