Original Contribution
Correlation of the Canadian Pediatric Emergency Triage and Acuity Scale to ED resource utilization

https://doi.org/10.1016/j.ajem.2008.02.024Get rights and content

Abstract

Objectives

The aim of this study was to find if there is a correlation between acuity measured by the Canadian Pediatric Emergency Triage and Acuity Scale (Ped-CTAS) and resource utilization in a large tertiary academic emergency department (ED). If correlation exists, it may indicate that resource allocation was done in accordance with needs (the more acute the patient, the more resources needed). This may also be the basis for future consideration regarding resource allocation decisions.

Methods

All pediatric patients (0-19 years of age) who were seen in the ED during 12 randomly selected days between May 1, 2005, and April 30, 2006, were included in the study. Detailed information regarding number and types of investigations ordered was collected. To look at the aggregate use of resources, we used the unit of cost. Resource utilization was calculated using standardized cost lists, and results were used to explore the correlation between different Ped-CTAS levels and resource utilization. A fixed cost model was used to predict the remainder of costs, other than diagnostic services.

Results

Of the 1661 patients presenting during the study period, 1618 (97.4%) were included in the study. The mean laboratory, microbiology, imaging, and total investigational costs increased with increasing acuity. This difference was insignificant between the semiurgent and the nonurgent categories of the Ped-CTAS.

Conclusions

The Ped-CTAS level correlates well with resource utilization for patient management in the ED. Further research should focus on measuring nursing and physician time use for each Ped-CTAS level to more accurately document ED resource utilization.

Introduction

Emergency departments (EDs) have experienced a significant increase in patient visits, resulting in increased wait times and overcrowding recently [1], [2], [3], [4]. Efficient, safe, and responsible operation of ED uses triage to promote rapid identification of patients with urgent life-threatening conditions to implement proper and timely management and ensure that all patients are seen based on their acuity [5], [6], [7]. The Canadian Emergency Department Triage and Acuity Scale (CTAS), which has the endorsement of the Canadian Association of Emergency Physicians, the National Emergency Nurses Affiliation, and L'association des médecins d'urgence du Québec [5], [6], was nationally implemented in October 1999 and revised in 2003. It is based on the Australasian National Triage Scale [8], [9], with Canadian modifications. The Canadian Pediatric Emergency Triage and Acuity Scale (Ped-CTAS) was developed in conjunction with the Canadian Pediatric Society, to account for age, developmental stage, acuity, family dynamics, cultural, and social variables that are important in the pediatric population [10].

Although not originally designed to serve as such, if Ped-CTAS correlates well with resource utilization of diagnostics in the ED, it may serve as a tool to indicate that resources are allocated according to acuity (ie, need) but can potentially be the baseline to the development of tools to more accurately predict future utilization. Initial studies show that CTAS can predict admission rates, hospital length of stay, and diagnostic utilization, as well as ED length of stay and blood tests [11], [12], [13], [14], [15]. A recent study on the validity of an electronic version of CTAS (not pediatric CTAS) did show significant correlation to total inpatient and ED cost [16]. We are unaware of additional studies that specifically compared a patient's triage score with ED resource utilization of diagnostic services. Although few papers examined ED cost analysis, they did not draw any conclusions regarding resource utilization correlation to patient acuity [17], [18], [19], [20]. A small number of previous studies have shown correlation between Ped-CTAS and admission rates, ED length of stay, and ED investigational rates [15], [21]. With increased utilization of EDs and a growing focus placed on efficient use of available resources, the role of Ped-CTAS in planning resource allocation may increase.

Our aim was to determine the correlation between costs of resource utilization in the ED with respect to Ped-CTAS in a large tertiary academic center in Canada.

Section snippets

Study design and setting

This retrospective study was carried out in the ED of The Hospital for Sick Children in Canada, a university-affiliated pediatric tertiary care hospital with approximately 50 000 annual ED patient visits. Staff at the ED consists of pediatric emergency physicians, subspecialty fellows, residents, medical students, and registered nurses. Triage nurses, who have all received standardized formal training in the use of Ped-CTAS, completed the Ped-CTAS evaluations.

Study participants

The selected study period consisted

Ped-CTAS specific demographics

Of a total 52 490 children registered at the ED during the study period, a total of 1618 records were included in the analysis (Fig. 1). Table 1 shows the demographic distribution of the study population. There were no significant differences in sex or language spoken at home between the different Ped-CTAS triage groups. The older the patient, the higher the acuity as registered by the nurses using Ped-CTAS. There were significant differences between Ped-CTAS groups and the chief complaints at

Discussion

We found that higher-acuity Ped-CTAS is associated with higher costs of resource utilization of diagnostic services in our ED. There was a higher total investigational cost and, subsequently, cost of patient management in the ED. This is important because it may allow Ped-CTAS to be used as a tool to indicate resource allocation in the ED and, in the future, to potentially serve as a basis to planning allocation.

The results of this study show that Ped-CTAS correlates well with laboratory

Conclusions

Based on the study results, patient's Ped-CTAS levels correlates well for ED diagnostic costs and, ultimately, total resource utilization in the ED.

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