title: Low compliance with a validated system for emergency department triage.
abstract: BACKGROUND
  Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have a "primary criterion" or a BEWS ≥ 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital.
  
  
  METHODS
  Retrospective evaluation of the triage of a random sample of 300 ED patients. ED medical charts were searched for "primary criteria", documentation of vital signs and a BEWS score. If a BEWS score had not been calculated, this was done retrospectively by the author. An evaluation was made to determine whether ECs or TCs had been correctly activated.
  
  
  RESULTS
  In 47 patients, all five vital signs for calculation of a BEWS had been documented. A BEWS had been calculated in 22 patients. Nine patients had a TC activation criterion, and in all these cases a TC was activated. A total of 48 patients had an EC activation criterion, but an EC had only been activated in 24 patients. Among the 24 patients for whom an EC had not been activated, eight had a "primary criterion" and 16 patients had a retrospective BEWS ≥ 5.
  
  
  CONCLUSIONS
  The triage system is not being used systematically and documentation of vital signs is insufficient at Bispebjerg Hospital. As a consequence, many patients who are presumed to be critically ill are not allocated to an EC. Initiatives have been taken to raise compliance with the system.
authors.affiliation: Department of Anaesthesiology, Bispebjerg Hospital, Virum, Denmark. dortheafc@gmail.com
authors.forename: Dorthea
authors.initials: D
authors.lastname: Christensen
authors.forename: Nanna Martin
authors.initials: NM
authors.lastname: Jensen
authors.forename: Rikke
authors.initials: R
authors.lastname: Maaløe
authors.forename: Søren Steemann
authors.initials: SS
authors.lastname: Rudolph
authors.forename: Bo
authors.initials: B
authors.lastname: Belhage
authors.forename: Hans
authors.initials: H
authors.lastname: Perrild
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000453:epidemiology*; D020000:Decision Support Systems, Clinical; D003718:Denmark; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D055986:Vital Signs; D055815:Young Adult