Validity Of Peking Union Medical College Hospital Emergency Triage Standards

Background:Emergency department(ED) visits have increased all over the world recently.Efficient triage can detect actually ill patients, and ensure that patients are treated in the most appropriate treatment area, in the order of their clinical urgency. The commonly used foreign triage scales have good reliability and validity, and have updated to adapt to the demand of the emergency department. Peking Union Medical College Hospital (PUMCH) emergency triage standards is a4-level (4L) triage scale, and has put used in PUMCH since2006. However, little previous research of the validity of this tool has been performed.Objectives:To examine the validity of PUMCH emergency triage standards on the basis of hospitalization, in-hospital mortality and resource utilization.Methods:The reseacher included the patients visited the PUMCH ED for the first time because the symptoms from August2013to December2013by convenience. Several variables were abstracted,including data of patients Social demographic,trige level,clinic department,outcomes and medical resources. Chi-square test and Fisher’s exact test were used to assesse the relationship between triage level and mortality and resource utilization.Results:Of the1640patients in this study,62.6%were female. The mean age across all patients was44.64+19.02years. Patients Triaged by nurses were as follows:1(1.6%),2(4.0%),3(31.3%),4(63.1%), by computer-based triage system were as follows:1(1.7%),2(5.8%),3(36.5%),4(56%). Hospitalization, admmitted to intensive care unite and in-hospital mortality was3.7%,0.8%and0.8%respectively.30.9%patients used more than2medical resources, while2.1%patients used life-saving interventions. For the level1patients triaged by nurses, hospitalization, adimmited to ICU, in-hospital mortality, rate of using more than2medical resources and rate of using life-saving interventions were53.8%、23.1%、26.9%、100%and69.2%respectively, while each rate of the indicators was0.6%、0.0%、0.1%、22.1%and0.1%for the level4patients,respectively. The likelyhood of hospitalization (Fisher’s exact test,P=0.000), adimmited to ICU(Fisher’s exact test,P=0.000), in-hospital mortality (Fisher’s exact test,P=0,000) and resource utilization (Fisher’s exact test,P=0.000) clearly increased as patients triage level decreases, and so as to the computer-based triage system, however, there was no difference between level3and level4patients triaged by computer-based triage system. Only1.4%patients sufferd from accidents (ie. have to transport to emergency room).Conclusions:The PUMCH emergency triage standards is a triage tool with high reliability and validity for the initially visited patients. To the computer-based triage system, it can not accurately distinguish the disease severity between level3and level4patients, so this triage system still needs to be further improvement.