title: A pragmatic triage system to reduce length of stay in medical emergency admission: feasibility study and health economic analysis.
abstract: BACKGROUND
  Departments of Internal Medicine tend to treat patients on a first come first served basis. The effects of using triage systems are not known.
  
  
  METHODS
  We studied a cohort in an Acute Medical Unit (AMU). A computer-assisted triage system using acute physiology, pre-existing illness and mobility identified five distinct risk categories. Management of the category of very low risk patients was streamlined by a dedicated Navigator. Main outcome parameters were length of hospital stay (LOS) and overall costs. Results were adjusted for the degree of frailty as measured by the Clinical Frailty Scale (CFS). A six month baseline phase and intervention phase were compared.
  
  
  RESULTS
  6764 patients were included: 3084 in the baseline and 3680 in the intervention phase. Patients with very low risk of death accounted for 40% of the cohort. The LOS of the 1489 patients with very low risk of death in the intervention group was reduced by a mean of 1.85days if compared with the 1276 patients with very low risk in the baseline cohort. This was true even after adjustment for frailty. Over the six month period the cost of care was reduced by £250,158 in very low patients with no increase in readmissions or 30day mortality.
  
  
  CONCLUSIONS
  Implementation of an advanced triage system had a measurable impact on cost of care for patients with very low risk of death. Patients were safely discharged earlier to their own home and the intervention was cost-effective.
authors.affiliation: School of Medical Sciences, Bangor University, Bangor, United Kingdom.
authors.forename: C P
authors.initials: CP
authors.lastname: Subbe
authors.affiliation: Nenagh Hospital, Nenagh, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Kellett
authors.affiliation: NWORTH, Clinical Trials Unit, Bangor University, Bangor. United Kingdom.
authors.forename: C J
authors.initials: CJ
authors.lastname: Whitaker
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Jishi
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: White
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Price
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Ward-Jones
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Australia.
authors.forename: R E
authors.initials: RE
authors.lastname: Hubbard
authors.affiliation: Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Eeles
authors.affiliation: Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Williams
mesh_terms: D000368:Aged; D000465:Algorithms; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014218:Triage / Q000379:methods*
keywords: Emergency admission; Frailty; Internal medicine; Length of stay; Triage