title: Triage-based resource allocation and clinical treatment protocol on outcome and length of stay in the emergency department.
abstract: OBJECTIVE
  The present study aimed to determine the relationship between the triage-based resource allocation and clinical treatment (TRACT) protocol and mortality and length of stay (LOS) in ED.
  
  
  METHODS
  This before-and-after study was conducted in an adult, tertiary, teaching hospital ED from August 2008 to July 2012. Patients who were younger than 18 years of age, who were dead on arrival and whose triage information was not available were excluded. TRACT was implemented in August 2010, and the Emergency Severity Index (ESI) was used for triage. Primary and secondary outcomes were ED mortality and ED LOS. Multivariate logistic regression models for ED mortality and multivariable general linear models on the ED LOS were used to compare the before- and after-intervention periods.
  
  
  RESULTS
  For the 155 563 visits over study period, the ED mortality rate was 0.2%, and the ED LOS was 4.6 h (median). The adjusted odds ratios (95% confidence intervals [CIs]) of the TRACT protocol on ED mortality were 0.69 (0.54-0.88) for total patients, 0.42 (0.30-0.59) for ESI 1, 1.04 (0.66-1.65) for ESI 2 and 1.45 (0.76-2.75) for ESI 3 group. The adjusted coefficients (95% CIs) of the TRACT on the ED LOS were -88.1 (-96.9 ∼ -79.2) min for all patients, -44.9 (-72.0 ∼ -17.9) min for ESI level 2 and -104.3 (-114.7 ∼ -94.0) min for ESI level 3.
  
  
  CONCLUSIONS
  The TRACT protocol decreased the ED mortality in ESI 1 group and reduced the ED LOS in ESI levels 2 and 3 groups.
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.affiliation: Department of Emergency Medicine, Gachon University Gil Hospital, Gyeonggi, Korea.
authors.forename: Jin Sung
authors.initials: JS
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003441:Crowding; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D040841:Resource Allocation / Q000458:organization & administration*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*; D055815:Young Adult
keywords: crowding; emergency department; mortality; triage