Analysis of the Proportion of Patients Who Were Admitted to the Emergency Department of the Tertiary Care Hospital for Primary Care

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.

Relevance of emergency level assessment by the Korean Triage and Acuity Scale for adult patients in a local emergency medical center

OBJECTIVE: The Korean Triage and Acuity Scale (KTAS), which was implemented in 2016, needs to be assessed for its validity and reliability. Here we evaluate the relevance of emergency level assessment by analyzing the validity of KTAS as a Korean standardized triage system. METHODS: We retrospectively analyzed the medical records of adults who presented to a local emergency room (ER) during an 18-month period. We compared medical resources used, life-saving interventions performed, length of stay (LOS) in ER, admission rate, and mortality at each KTAS level. RESULTS: Among a total of 40,339 patients, most patients were at KTAS 4 (n=19,532, 48.4%) and the longest median LOS in ER was 450 minutes at KTAS 2. As the KTAS level increased, the percentage of medical resources used and life-saving interventions performed increased significantly. The odds of total admission and intensive care unit admission were significantly higher at KTAS 1 through 4 compared to those at KTAS 5. The odds related to admission and mortality were also significantly higher at KTAS 3 than at KTAS 4. CONCLUSION: We concluded that the KTAS, as a Korean standardized triage system of emergency level assessment, is relevant. Further, KTAS 1-3 and KTAS 4-5 are appropriate criteria to distinguish emergency and non-emergency patients.

Clinical Considerations When Applying Vital Signs in Pediatric Korean Triage and Acuity Scale

Initial vital signs of children at the emergency department may be abnormal because of anxiety and irritability, resulting in unrealistic triage levels. This study aimed to evaluate the effectiveness of pediatric triage by clinical decision based on the patient's general condition. The Pediatric Korean Triage and Acuity Scale (PedKTAS) has been used nationwide for triage since 2016. The triage level, as assessed by an experienced triage nurse and based on the patient's clinical condition, was defined as the ‘real practice (RP)-level,’ while the re-calculated triage level, as assessed by the direct application of initial vital signs, was defined as the ‘simulation (S)-level.’ A total of 22,841 patients were triaged during the study period. The hospitalization rate according to RP-PedKTAS levels exhibited a significant correlation with the expected hospitalization rate suggested by the Pediatric Canadian Triage and Acuity Scale (CTAS) (P = 0.002), whereas the S-PedKTAS levels did not (P = 0.151). Compared with the previously reported pediatric CTAS level-specific hospitalization rate and intensive care unit (ICU) admission rate, RP-PedKTAS was significantly correlated with both hospitalization rate and ICU admission rate (P = 0.001 and P = 0.012, respectively). However, S-PedKTAS showed no significant correlation in both (P = 0.267 and P = 0.188, respectively). The determination of triage levels based on clinical decision rather than the direct application of abnormal initial vital signs to PedKTAS is more accurate in predicting the hospitalization rate and ICU admission rate.

Validation of the Korean Triage and Acuity Scale Compare to Triage by Emergency Severity Index for Emergency Adult Patient: Preliminary Study in a Tertiary Hospital Emergency Medical Center

PURPOSE: Triage is the initial clinical evaluation process in a hospital emergency department (ED). The Korean Triage and Acuity Scale-based triage system (KTAS) has been developed and used in Korean EDs as a triage tool. However, there has been limited evidence of its reliability and validation in KTAS. The aim of this study was to validate KTAS by comparing the Emergency Severity Index (ESI). METHODS: This was a prospective study. All adult patients over the age of 18 years who visited our ED during the study period were included. Patients were independently triaged by a primary triage nurse using KTAS and emergency physician by ESI. The total admission rate (TAR) and length of stay (LOS) were analyzed by comparing KTAS and ESI according to acuity levels. RESULTS: A total of 2919 patients were enrolled in our study. With KTAS, 0.8%, 9.3%, 41.6%, 39.7%, and 8.6% were assigned to the levels 1, 2, 3, 4, and 5, respectively. With ESI, 1.8%, 15.7%, 38.4%, 42.5%, and 1.6% were assigned to levels 1, 2, 3, 4, and 5, respectively. The percentage of each level using KTAS was similar to using ESI. Significant consistency existed in TAR and LOS compared with KTAS and ESI. CONCLUSION: KTAS seems preferable to triaged patients according to severity. It is helpful to order of priority in utilization for ED.