gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

08. - 11.09.2019, Dortmund

Influence of the Presentation of the Target Time of the Manchester Triage System on the Real Waiting Time in Emergency Departments: A Prospective Cross-Over Study

Meeting Abstract

  • Jonas Bienzeisler - Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
  • Bernadett Erdmann - Klinikum Wolfsburg, Wolfsburg, Germany
  • Guido Becker - Agfa HealthCare GmbH, Bonn, Germany
  • Dominik Brammen - Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
  • Volker Sebastian Thiemann - Carl von Ossietzky Universität, Oldenburg, Germany
  • Fabian Otto-Sobotka - Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
  • Rainer Röhrig - Uniklinik RWTH Aachen, Aachen, Germany

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. 64. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Dortmund, 08.-11.09.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAbstr. 249

doi: 10.3205/19gmds049, urn:nbn:de:0183-19gmds0495

Veröffentlicht: 6. September 2019

© 2019 Bienzeisler et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Introduction: Due to crowding, it becomes necessary to carefully decide the sequence of treatment in the emergency department (ED) [1]. Using the Manchester Triage System (MTS), a nurse assigns patients arriving with a triage score, determining a target time for treatment. Processing times are important metrics for quality assessment in the ED. Using a Dutch version of the MTS, Storm-Versloot et al. [2] reported refined processing of patients using the MTS, while Vegting et al. [3] observed an increase in the length of stay only. Thus, the effects of the MTS on processing times have been reported inconsistently. It is also known that measures becoming target cease to be good measures, yet it is still common practice to display MTS target times to personnel [4], [5]. Thus, we hypothesized that displaying target times in the hospital information system (HIS) to practicing physicians effects processing and waiting times and hence patient flow.

Methods: We conducted a prospective, single-center, cross-over study of adult patients treated before (P1, n = 35,167) and after (P2, n = 10,655) the introduction of a HIS module with a novel user interface that did not advertise MTS target times. The study commenced after receiving the ethics committee vote (University Oldenburg, Vote-No: 2016-051, Chair F. Griesinger). Descriptive analysis in R included median and inter quartile range (IQR) for metric variables and frequencies for categorical variables. We conducted multivariate analyses in R with generalized additive regression models. Metric covariates were included in the models via P-splines. Variable selection was performed using the Akaike Information Criterion (AIC). Regression results are reported as odds ratios with 95% confidence intervals.

Results: We observed a prolonged length of stay in P2 ( P1 = 119 min., IQR = 66-189, P2 = 148 min., IQR = 88-226). The target time was missed in a greater number of triaged cases in P2 ( 3.87%). However, practicing physicians reported improved patient flow. A logistic model estimated that timely treatment after triage, depending on the severity of the case, was significantly more likely in P2 (OR 3.13, CI 1.95-5.00 for P2). A generalized additive regression model showed a significantly lower waiting time of severe cases in P2 (down to 0.15 times the previous value for P1, CI 0.08-0.26).

Discussion: The introduction of the new HIS module resulted in a more refined triage compensating for crowding. However, effects of minor changes that accompanied the introduction of the new HIS module could not be addressed. These can be neglected as these were either cosmetic or impacted the triage process itself, which does not influence the waiting time after triage. However, the influence of raised awareness of ED personal in general cannot be considered given the setting of the study.

Conclusions: It can be beneficial for patient flow and quality of treatment to stop advertising target times in the HIS when using the MTS. Undesired incentives [5] caused by a target time can be avoided.

Acknowledgements: The authors acknowledge the AKTIN-Research-Group and the financial support by the BMBF (No. 01KX1319A).

Competing interests: Guido Becker is affiliated with AGFA Healthcare.

The authors declare that a positive ethics committee vote has been obtained.


References

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