J Korean Soc Emerg Med.  2018 Apr;29(2):144-151. 10.0000/jksem.2018.29.2.144.

Relationship between emergency department disposition, level of emergency base on Korean Triage and Acuity Scale, visit mode

Affiliations
  • 1Department of Emergency Medicine, Pusan National University Hospital, Pusan, Korea. csjmedigate@naver.com
  • 2Department of Emergency Medicine, Pusan National University Yangsan Hospital, Pusan, Korea.
  • 3Department of Emergency Medical Technology, Sungduk University, Youngcheon, Korea.
  • 4Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 5Department of Emergency Medical Technology, Dongju University, Pusan, Korea.

Abstract


OBJECTIVE
The policy to judge the level of emergency (emergent vs non-emergent) based on Korean Triage and Acuity Scale (KTAS) has been introduced by government to control the flow of emergency patients. The purpose of this study is to identify the variables expected to affect the disposition and to compare the relative importance of the variables. And we also evaluate the validity of the policy to judge the level of emergency based on KTAS.
METHODS
We enrolled a total of 29,865 patients who visited a Wide Regional Emergency Center in Busan from Jan 2016 to Dec 2016. Data of those patients were extracted from National Emergency Department Information System (NEDIS) and analysed retrospectively. We determined disposition as the outcome variable. We evaluated the relationship between disposition and visit time, visit mode (firehouse ambulance, inter-facility transfer and self-transport), level of emergency based on KTAS, cause of morbidity. And we also evaluated general and conditional dominances of those variables to compare their relative importance each other.
RESULTS
The disposition of the patients was discharge to home (53.5%), general ward admission (30.3%), intensive care unit admission (11.6%), and inter-facility transfer (4.8%). In the univariate analysis, age, gender, visit time, visit mode, cause of morbidity, KTAS level had a significant effect on the disposition. All variables that had a significant effect on univariate analysis also had a significant effect on disposition in multivariate analysis. As a result of dominance analysis, visit mode was the most important variable in both general dominance and conditional dominance. However, if KTAS was devided into 5 levels, it was the most important variable.
CONCLUSION
Level of emergency based on KTAS was significantly effective on patient disposition, however it was relatively less important compared to the visit mode. If the visit mode is reflected in the triage system, triage accuracy is expected to be improved. And it also can be a good option to construct triage system based on 5 level KTAS.

Keyword

Triage; Emergency medical services; Emergency department; Disposition

MeSH Terms

Ambulances
Busan
Emergencies*
Emergency Medical Services
Emergency Service, Hospital*
Humans
Information Systems
Intensive Care Units
Multivariate Analysis
Patients' Rooms
Retrospective Studies
Triage*
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