Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study
Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-02-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/14/2/195 |
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| author | Gabriele Savioli Iride Francesca Ceresa Maria Antonietta Bressan Gaia Bavestrello Piccini Viola Novelli Sara Cutti Giovanni Ricevuti Ciro Esposito Yaroslava Longhitano Andrea Piccioni Zoubir Boudi Alessandro Venturi Damiano Fuschi Antonio Voza Roberto Leo Abdelouahab Bellou Enrico Oddone |
| author_facet | Gabriele Savioli Iride Francesca Ceresa Maria Antonietta Bressan Gaia Bavestrello Piccini Viola Novelli Sara Cutti Giovanni Ricevuti Ciro Esposito Yaroslava Longhitano Andrea Piccioni Zoubir Boudi Alessandro Venturi Damiano Fuschi Antonio Voza Roberto Leo Abdelouahab Bellou Enrico Oddone |
| author_sort | Gabriele Savioli |
| collection | DOAJ |
| description | Elderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs. |
| first_indexed | 2024-03-07T22:24:54Z |
| format | Article |
| id | doaj.art-8bac6c6988014e9dab2c762fface2123 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-07T22:24:54Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-8bac6c6988014e9dab2c762fface21232024-02-23T15:23:49ZengMDPI AGJournal of Personalized Medicine2075-44262024-02-0114219510.3390/jpm14020195Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) StudyGabriele Savioli0Iride Francesca Ceresa1Maria Antonietta Bressan2Gaia Bavestrello Piccini3Viola Novelli4Sara Cutti5Giovanni Ricevuti6Ciro Esposito7Yaroslava Longhitano8Andrea Piccioni9Zoubir Boudi10Alessandro Venturi11Damiano Fuschi12Antonio Voza13Roberto Leo14Abdelouahab Bellou15Enrico Oddone16Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, ItalyEmergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, ItalyDepartment of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, ItalyEmergency Medicine, Université Libre de Bruxelles (ULB), 1050 Brussels, BelgiumMedical Direction, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, ItalyMedical Direction, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, ItalyDepartment of Drug Science, University of Pavia, 27100 Pavia, ItalyNephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, ItalyResidency Program in Emergency Medicine, Department of Emergency Medicine, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyEmergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyDepartment of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab EmiratesDepartment of Political and Social Sciences, University of Pavia, 27100 Pavia, ItalyDepartment of Italian and Supranational Public Law, Faculty of Law, University of Milan, 20133 Milan, ItalyEmergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, ItalyDepartment of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, ItalyGlobal Network on Emergency Medicine, Brookline, MA 02446, USADepartment of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, ItalyElderly patients, when they present to the emergency department (ED) or are admitted to the hospital, are at higher risk of adverse outcomes such as higher mortality and longer hospital stays. This is mainly due to their age and their increased fragility. In order to minimize this already increased risk, adequate triage is of foremost importance for fragile geriatric (>75 years old) patients who present to the ED. The admissions of elderly patients from 1 January 2014 to 31 December 2020 were examined, taking into consideration the presence of two different triage systems, a 4-level (4LT) and a 5-level (5LT) triage system. This study analyzes the difference in wait times and under- (UT) and over-triage (OT) in geriatric and general populations with two different triage models. Another outcome of this study was the analysis of the impact of crowding and its variables on the triage system during the COVID-19 pandemic. A total of 423,257 ED presentations were included. An increase in admissions of geriatric, more fragile, and seriously ill individuals was observed, and a progressive increase in crowding was simultaneously detected. Geriatric patients, when presenting to the emergency department, are subject to the problems of UT and OT in both a 4LT system and a 5LT system. Several indicators and variables of crowding increased, with a net increase in throughput and output factors, notably the length of stay (LOS), exit block, boarding, and processing times. This in turn led to an increase in wait times and an increase in UT in the geriatric population. It has indeed been shown that an increase in crowding results in an increased risk of UT, and this is especially true for 4LT compared to 5LT systems. When observing the pandemic period, an increase in admissions of older and more serious patients was observed. However, in the pandemic period, a general reduction in waiting times was observed, as well as an increase in crowding indices and intrahospital mortality. This study demonstrates how introducing a 5LT system enables better flow and patient care in an ED. Avoiding UT of geriatric patients, however, remains a challenge in EDs.https://www.mdpi.com/2075-4426/14/2/195triageemergency servicehospitalcrowdingtriage (under-triage)triage (over-triage) |
| spellingShingle | Gabriele Savioli Iride Francesca Ceresa Maria Antonietta Bressan Gaia Bavestrello Piccini Viola Novelli Sara Cutti Giovanni Ricevuti Ciro Esposito Yaroslava Longhitano Andrea Piccioni Zoubir Boudi Alessandro Venturi Damiano Fuschi Antonio Voza Roberto Leo Abdelouahab Bellou Enrico Oddone Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study Journal of Personalized Medicine triage emergency service hospital crowding triage (under-triage) triage (over-triage) |
| title | Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study |
| title_full | Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study |
| title_fullStr | Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study |
| title_full_unstemmed | Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study |
| title_short | Geriatric Population Triage: The Risk of Real-Life Over- and Under-Triage in an Overcrowded ED: 4- and 5-Level Triage Systems Compared: The CREONTE (Crowding and R E Organization National TriagE) Study |
| title_sort | geriatric population triage the risk of real life over and under triage in an overcrowded ed 4 and 5 level triage systems compared the creonte crowding and r e organization national triage study |
| topic | triage emergency service hospital crowding triage (under-triage) triage (over-triage) |
| url | https://www.mdpi.com/2075-4426/14/2/195 |
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