ED triage of patients with acute myocardial infarction: predictors of low acuity triage☆
Received 6 January 2009; received in revised form 11 March 2009; accepted 13 March 2009. published online 26 March 2010.
Abstract
Objective
Virtually all emergency department (ED) patients receive an ED triage assessment that determines their priority to be seen by a physician. Previous research found that half of patients who are having an acute myocardial infarction (AMI) are given a low priority triage score, which is associated with delays in electrocardiogram (ECG) acquisition and reperfusion therapy. We sought to determine some of the reasons why ED triage is failing in these patients.
Methods
We conducted a retrospective cohort analysis of a population-based cohort of AMI patients admitted to 102 acute care hospitals in Ontario, Canada, from July 2000 to March 2001. We examined 10 potential patient- and hospital-level predictors of low acuity triage: age, sex, number of comorbidities, arrival mode, socioeconomic status, time of day, day of week, ED AMI volume, hospital type, and department use of triage ECGs.
Results
Mean age of the 3088 patients was 67.5 (SD, 14.0), and 65% were men. In adjusted quantile regression analyses, low acuity triage was independently associated with ED AMI volume (odds ratio [OR], 0.44 at very high volume centers), arrival mode (OR, 0.60 for ambulance arrival), sex (OR, 0.80 for males), age (OR, 1.1 per 10 years of age), and a low number of comorbidities (OR, 0.92 for every cardiac co-morbidity).
Conclusions
Low acuity ED triage of AMI patients may be predicted by several patient- and hospital-level characteristics. Focusing future interventions on these factors may improve ED triage and, subsequently, time to initial ECG and reperfusion, in this patient group.
aInstitute for Clinical Evaluative Sciences, Toronto, ON, Canada M4N 3M5
bDivision of Emergency Medicine, Department of Medicine, University of Toronto, and Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5
cCardiology and General Internal Medicine, Department of Medicine, University of Toronto, and Sunnybrook Health Sciences Centre, Toronto, ON, Canada M4N 3M5
Corresponding author. Institute of Clinical Evaluative Sciences, Toronto, ON, Canada M4N 3M5. Tel.: +1 416 480-6100 x3798.
☆ This project was supported in part by a Canadian Insitutes of Health Research (CIHR) Team Grant in Cardiovascular Outcomes Research, an operating grant from the Heart and Stroke Foundation of Ontario (NA5703), and the Department of Medicine Clinician-Scientist Program at the University of Toronto. Dr Atzema was supported by a Fellowship Award from CIHR, and Dr Schull was supported by a New Investigator Award from CIHR. Dr Tu was supported by a Canada Research Chair in Health Services Research and by a Career Investigator award from the Heart and Stroke Foundation of Ontario. This study was also supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.
ABSTRACT