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Authors: Abdullah Shalabi , Omar Alsharqi , Maweyah Alnujaidi , Rawan Alosaimy , Ebtehal Altalhi , Rozan Kashmeeri , Raghad Aldibane

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Abstract

Background: The Canadian Triage and Acuity Scale (CTAS) is a scale that identifies the urgency of the case and helps to determine the time needed to be assessed by the physician in the emergency department (ED). However, further research is needed to identify factors that need to be taken into consideration in future CTAS to avoid misclassification of non-urgent patients at high risk who need admission and can be triaged away from the ED. The aim of the study was to evaluate the admission of non-urgent patients to decrease the burden on the ED by triaging them away from primary health care (PHC). Methods: A descriptive-analytical retrospective cohort study was performed including all patients who presented to the ED of King Abdullah Medical Center, Makkah, during a period starting on 9 May 2019 and were classified as CTAS levels 4 and 5. Data of those patients regarding CTAS levels, sex, age, ED visit, vital signs at triage time, pain score, chief complaint, and past medical history extracted from their electronic medical records were entered into the Statistical Package for Social Sciences software (SPSS), and multivariate logistic regression was used to identify predictors of admission. Results: CTAS IV and CTAS V patients accounted for 30.3% (2509/8277) of the total ED visits. The admission rate was 6.1%. Multivariate logistic regression analysis revealed that female patients were 48% less likely to be admitted than males (adjusted odds ratio "AOR": 0.52, 95% confidence interval "CI": 0.36-0.74). Patients who presented with nausea/vomiting had an almost double chance for admission (AOR: 2.03, 95% CI: 1.09-3.79). Patients with a history of hypertension (AOR: 2.39, 95% CI: 1.68-3.40), cancer patients (AOR: 3.02, 95% CI: 2.11-4.32), and patients who presented with a respiratory rate exceeding 20/minute (AOR: 4.88, 95% CI: 1.45- 16.40) were more likely to be admitted than their counterparts. Conclusion: Non-urgent visits to EDs are common practice, and a considerable percentage of patients were admitted. All CTAS V cases can be safely triaged away to the PHC; CTAS IV can be either triaged away to PHC or to the urgent care center taking into consideration whether the patient is tachypneic, hypertensive or an oncology patient.

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Keywords: Emergency department, non-urgent, Canadian triage and acuity scale, triage, factor

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