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Applied Health Economics and Health Policy
Published in: Applied Health Economics and Health Policy 6/2017

01-12-2017 | Original Research Article

Robustness and Effectiveness of the Triage System in the Pediatric Context

Authors: Marcello Montefiori, Enrico di Bella, Lucia Leporatti, Paolo Petralia

Published in: Applied Health Economics and Health Policy | Issue 6/2017

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Abstract

Background

The increasing use of emergency departments (EDs) potentially compromises their effectiveness and quality. The evaluation of the performance of the triage code system in a pediatric context is important because waiting time affects the quality of care for acutely ill patients.

Objective

In this study, we aimed to assess the effectiveness and robustness of the triage code system in a pediatric context and identify the determinants of waiting times for urgent and non-urgent patients.

Methods

Data regarding 37,767 pediatric patients who accessed the ED of a major Italian pediatric hospital in 2015 were investigated in order to study patient numbers and waiting times. The determinants of waiting times for urgent and non-urgent patients, as well as variables referring to the “supply side,” such as periods of staff shortage, were analyzed using a survival analysis framework.

Results

For urgent patients, the waiting time between triage and the first physician assessment is generally below the standard threshold of 15 min and this is not affected by the number of non-urgent patients waiting for care. Conversely, the waiting time for non-urgent patients is affected by ED flow, periods of staff shortage, and non-clinical variables (age and nationality).

Conclusion

Our results suggest that the triage level assignation system is effective in terms of safety for urgent patients. The current ED organization adequately fulfills its primary goal of providing healthcare for acutely ill patients.
Footnotes
1
Data refer to accesses, not to the number of patients. In other words, patients who accessed ED many times per year were counted multiple times.
 
2
We dropped 25 non-urgent patients waiting for over 500 min and five urgent patients waiting for over 300 min due to an administrative failure of the medical staff to close the cases on the patient-tracking system.
 
3
Decreto Legislativo 30 giugno 2003, n. 196.
 
4
Day and night shifts were split into 2-h slots and the number of urgent and non-urgent patients attending the ED during the 2-h time slots was used to assess ED flow.
 
5
Gaslini Children’s Hospital Emergency Department is both a medical and a surgical pediatric emergency department. It includes the Short Term Intensive Observation (eight beds) and the Emergency Medicine Ward (12 beds). There is one single medical team working in all sections of the Department, while there are two different nursing teams and two head nurses, one for the ER and one for the Emergency Medicine Ward.
The medical staff of the Emergency Department is supplemented by additional surgical staff belonging to the Pediatric Surgery Unit of the Hospital.
Day shift (12 h; 365 days): n. 2 pediatricians and n. 1 pediatric surgeon.
Night shift (12 h; 365 days): n. 1 pediatrician and n. 1 pediatric surgeon.
Furthermore, n. 1 radiologist and n. 1 technician in medical radiology are always available 24 h a day in the Emergency Department.
Regarding ER nursing staff (excluding the Emergency Medicine Ward, which has a dedicated nursing team), there are six shifts of n. 4 nurses each, n. 4 day shift nurses and n. 1 head nurse. The ER medical and nursing staff is supplemented by n. 1 healthcare assistant.
 
6
All of the analyses discussed below are based on the records of the 36,760 admissions at the Gaslini ED. This large number of observations determines that all the statistical tools herein applied may detect statistically significant effects with a sensibility that is far higher than that generally used by policy makers. For instance, due to the large sample size, even small differences in mean among groups may be statistically significant albeit such a difference may not be relevant to the policy maker. Therefore, here we discuss the results of the analyses, focusing on what the statistical models outline as statistically significant, but we also take into account the absolute values of what is detected to be significant.
 
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Metadata
Title
Robustness and Effectiveness of the Triage System in the Pediatric Context
Authors
Marcello Montefiori
Enrico di Bella
Lucia Leporatti
Paolo Petralia
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
Applied Health Economics and Health Policy / Issue 6/2017
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI
https://doi.org/10.1007/s40258-017-0340-z

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