title: An Electronic Emergency Triage System to Improve Patient Distribution by Critical Outcomes.
abstract: Patient triage is necessary to manage excessive patient volumes and identify those with critical conditions. The most common triage system used today, Emergency Severity Index (ESI), focuses on resources utilized and critical outcomes.
  
  
  
  This study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes.
  
  
  
  This cross-sectional study of 25,198 (97 million weighted) adult emergency department visits from the 2009 National Hospital Ambulatory Medical Care Survey. The ETS distributes patients by using a composite outcome based on the estimated probability of mortality, intensive care unit admission, or transfer to operating room or catheterization suite. We compared the ETS with the ESI based on the differentiation of patients, outcomes, inpatient hospitalization, and resource utilization.
  
  
  
  Of the patients included, 3.3% had the composite outcome and 14% were admitted, and 2.52 resources/patient were used. Of the 90% triaged to low-acuity levels, ETS distributed patients evenly (Level 3: 30%; Level 4: 30%, and Level 5: 29%) compared to ESI (46%, 34%, and 7%, respectively). The ETS better-identified patients with the composite outcome present in 40% of ETS Level 1 vs. 17% for ESI and the ETS area under the receiver operating characteristic curve (AUC) was 0.83 vs. ESI 0.73. Similar results were found for hospital admission (ETS AUC = 0.83 vs. ESI AUC = 0.72). The ETS demonstrated slight improvements in discriminating patient resource utilization.
  
  
  
  The ETS is a triage system based on the frequency of critical outcomes that demonstrate improved differentiation of patients compared to the current standard ESI.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Andrea Freyer
authors.initials: AF
authors.lastname: Dugas
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland; Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland; Department of International Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kirsch
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Matthew
authors.initials: M
authors.lastname: Toerper
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Fred
authors.initials: F
authors.lastname: Korley
authors.affiliation: Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Gayane
authors.initials: G
authors.lastname: Yenokyan
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Daniel
authors.initials: D
authors.lastname: France
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Hager
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland; Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014218:Triage / Q000379:methods*; D055815:Young Adult
keywords: emergency medicine; patient acuity; resource allocation; triage; utilization