Comparison between Canadian Triage and Acuity Scale and Taiwan Triage System in emergency departments.
OBJECTIVE
Since the implementation of National Health Insurance in Taiwan, Emergency Department (ED) volume has progressively increased, and the current triage system is insufficient and needs modification. This study compared the prioritization and resource utilization differences between the four-level Taiwan Triage System (TTS) and the standardized five-level Canadian Triage and Acuity Scale (CTAS) among ED patients.


METHODS
This was a prospective observational study. All adult ED patients who presented to three different medical centers during the study period were included. Patients were independently triaged by the duty triage nurse using TTS, and a single trained research nurse using CTAS with a computer support software system. Hospitalization, length of stay (LOS), and medical resource consumption were analyzed by comparing TTS and CTAS by acuity levels.


RESULTS
There was significant disparity in patient prioritization between TTS and CTAS among the 1851 enrolled patients. With TTS, 7.8%, 46.1%, 45.9% and 0.2% were assigned to levels 1, 2, 3, and 4, respectively. With CTAS, 3.5%, 24.4%, 44.3%, 22.4% and 5.5% were assigned to levels 1, 2, 3, 4, and 5, respectively. The hospitalization rate, LOS, and medical resource consumption differed significantly between the two triage systems and correlated better with CTAS.


CONCLUSIONS
CTAS provided better discrimination for ED patient triage, and also showed greater validity when predicting hospitalization, LOS, and medical resource consumption. An accurate five-level triage scale appeared superior in predicting patient acuity and resource utilization.
Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chip-Jin
CJ
Ng
Kuang-Hung
KH
Hsu
Jen-Tze
JT
Kuan
Te-Fa
TF
Chiu
Wei-Kong
WK
Chen
Hung-Jung
HJ
Lin
Michael J
MJ
Bullard
Jih-Chang
JC
Chen
D000328:Adult; D000368:Aged; D002170:Canada; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D040841:Resource Allocation; D013624:Taiwan; D014218:Triage / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D055815:Young Adult