title: The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia.
abstract: Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making.
  
  
  
  This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration.
  
  
  
  1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82).
  
  
  
  By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. michael.dinh@sswahs.nsw.gov.au.|Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia. michael.dinh@sswahs.nsw.gov.au.|Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, 2050, Australia. michael.dinh@sswahs.nsw.gov.au.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Faculty of Nursing, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Saartje Berendsen
authors.initials: SB
authors.lastname: Russell
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.affiliation: The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Kris
authors.initials: K
authors.lastname: Rogers
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Muscatello
authors.affiliation: Discipline of Emergency Medicine, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.|Health Education and Training Institute, New South Wales Ministry of Health, Sydney, NSW, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Hayman
authors.affiliation: Emergency Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Dane R
authors.initials: DR
authors.lastname: Chalkley
authors.affiliation: The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.|School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009517:New South Wales; D010343:Patient Admission / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage / Q000379:methods*; D055815:Young Adult
keywords: Decision; Risk score; Triage