Article
Application of the RESCUE triaging system. Retrospective and prospective analysis of triaging quality
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Authors
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Tommaso Rossi
- Rome/Italy
| Published: | June 18, 2008 |
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Outline
Text
Purpose: Ophthalmic emergency (OE) triage is essential for prompt recognition of urgent cases. To date no formal eye-dedicated triaging system has been widely accepted. Purpose of present study is to propose a fast, accurate, and reproducible coding scale named Rome Eye system for SCoring Urgency and Emergency (RESCUE).
Design: phase I of the study is a retrospective analysis of Electronical Medical Records (EMR); phase II is a prospective consecutive series.
Participants: Phase I included 160,936 patients. Phase 2 included 1,000 consecutive patients referred to the Emergency Department of our Institution.
Methods: In phase 1 the authors retrospectively analyzed Electronic Medical Records (EMRs) of ER patients, listing signs and symptoms most frequently associated to hospitalization. Redness, pain, loss of vision and the risk for an “open eye” were identified and assigned a score ranging from 0 to 12. Colour coding was assigned based on increasing scoring: 0-3 white, 4-7 green, 8-12 yellow code. In phase 2, 1,000 consecutive ER patients were enrolled and prospectively coded according to RESCUE. After diagnosis and proper treatment, EMRs were retrospectively reviewed by a masked physician and patients re-coded (RETRO coding) according to clinical course. Correlation between RESCUE and RETRO coding was calculated.
Main Outcome Measures: Prospective and retrospective ER colour coding correlationResults: 160,936 EMR were retrospectively analyzed; 2,407 (1.4%) patients required hospitalization. Loss of vision (90%), redness (76%) and pain (47%), were the most frequent complaints. RESCUE significantly correlated to RETRO coding (p<0.01): 841/1,000 patients coded exactly the same colour, 45/1,000 have been overestimated by 1 colour class, none by 2, 107/1,000 underestimated by 1 and 6/1,000 by 2 classes. The 32/1,000 hospitalized patients in the prospective cohort had a RESCUE score significantly higher than non-admitted patients (p<0.01) and colour coding among admitted and dismissed patients was significantly different as well (p<0.01).
