The validity of the triage system ADAPT

Abstract

Conclusions This report uses the term triage in referring to systematic categorisation of emergency department (ED) patients according to their level of medical urgency, i.e., how quickly patients need to receive care based on their medical condition. Flow processes refer to various means used to organise the work of processing patients in the ED, with the aim of speeding up patient throughput. The report compiles findings from studies of patients that visited the ED, regardless of severity level. Hence, the effects of triage scales and/or flow processes on disease course and survival of specific diagnostic groups cannot be determined.Scientific studies of triage scales show that the risk of death shortly after triage is small in cases found to be least urgent. In this respect, triage scales are safe to use. Nevertheless, a small percentage of these patients may need to be admitted for hospital care. Consequently, patients cannot be referred, e.g., to primary care, from a hospital ED solely on the grounds of triage level. The scientific evidence is insufficient to determine the extent to which triage scales are reproducible, i.e., the frequency with which different evaluators reach the same conclusion. The scientific evidence is insufficient to determine if differences exist in safety, validity, and reliability among the three triage methods that are most common in Sweden, i.e., the Medical Emergency Triage and Treatment System (METTS), Adaptive Process Triage (ADAPT), and the Manchester Triage Scale (MTS). When ED routines are organised in different flow processes (e.g., a special process for patients with high probability of being admitted to hospital), this reduces the patient’s waiting time to see a physician and the overall length of stay in the ED. Since the various flow processes have not been studied head to head, it is not possible to determine which ones have the greatest effect. A so-called fast track (which involves using a special process to handle patients with minor disorders) is the flow process backed by the strongest scientific evidence. This flow process shortens the time before initial contact with a physician and shortens the length of stay in the ED. When the degree of medical urgency is assessed by a care team involving different categories of staff (physician, nurse, and nursing assistant or secretary) this is called team triage. This flow process can shorten the time before initial contact with a physician and shorten the length of stay in the ED. Team triage also leads to fewer patients spontaneously leaving the ED before they have been medically evaluated. Limited evidence suggests that the length of stay in the ED can be shortened if lab specimens are analysed in the ED, or if referrals for certain x-ray examinations are written by nurses instead of by physicians.