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Emergency Medicine and Critical Care Triage

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Compelling Ethical Challenges in Critical Care and Emergency Medicine

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Abstract

Triage is the French name for sorting. It is a common method used to discern who should be evacuated or treated first among a group of injured or severely ill patients. It has become a crucial function of the healthcare providers in charge of emergency services and overcrowded outpatient (clinics and emergency departments) or inpatient (trauma and intensive care units) environments. These areas are the most in need of an efficient and accurate system to identify the correct patients and the reason we focus on their challenges in this chapter. Triage is a very complex and challenging process, which requires knowledge, training, and experience. Unfortunately, having all the required skills does not guarantee an accurate triage.

Guidelines have been published to improve the management of the triage process, but their implementation is in itself also riddled by innumerable challenges. Increased volumes of patients in the emergency departments cause severe patient flow inefficiencies and throughput; solutions proposed to improve them do not seem to work consistently. Despite the plethora of tools available for triage in the emergency departments and hospital wards, there is still a need for more accurate and reliable instruments to reduce under- and over-triage. Intensive care units are not less challenging. Day-to-day utilization and surge responses are influenced by the appropriateness of the strategies and policies in place of each unit and hospital. In this chapter, we examine some of these practitioners’ daily struggles and enumerate potential solutions.

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References

  1. Society of Critical Care Medicine Ethics Committee. Consensus statement on the triage of critically ill patients. JAMA. 1994;271:1200–3.

    Article  Google Scholar 

  2. Nates JL, Nunally M, Kleinpell R, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44:1553–602.

    Article  Google Scholar 

  3. Blanch L, Abillama FF, Amin P, et al. Triage decisions for ICU admission: report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2016;36:301–5.

    Article  Google Scholar 

  4. Sprung CL, Zimmerman JL, Christian MD, et al. Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster. Intensive Care Med. 2010;36:428–43.

    Article  Google Scholar 

  5. Devereaux AV, Dichter JR, Christian MD, et al. Definitive care for the critically ill during a disaster: a framework for allocation of scarce resources in mass critical care: from a task force for mass critical care. Chest. 2007;133:S51–66.

    Article  Google Scholar 

  6. Fernandes CM, Tanabe P, Gilboy N, et al. Five-level triage: a report from the ACEP/ENA five-level triage task force. J Emerg Nurs. 2005;31:39–50.

    Article  Google Scholar 

  7. Rutschmann OT, Kossovsky M, Geissbuhler A, et al. Interactive triage simulator revealed important variability in both process and outcome of emergency triage. J Clin Epidemiol. 2006;59:615–21.

    Article  Google Scholar 

  8. Rathi N, Haque S, Feng L, et al. Variability of ICU triage practices in a cancer hospital. Crit Care Med. 2001;Suppl 39:604.

    Google Scholar 

  9. Chen LM, Render M, Sales A, et al. Intensive care unit admitting patterns in the Veterans Affairs Health Care System. Arch Intern Med. 2012;172:1220–6.

    Article  Google Scholar 

  10. Admon AJ, Seymor CW, Gershengorn HB, et al. Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism. Chest. 2014;146:1452–61.

    Article  Google Scholar 

  11. Sprung CL, Geber D, Eidelman LA, et al. Evaluation of triage decisions for intensive care admission. Crit Care Med. 1999;27:1073–9.

    Article  CAS  Google Scholar 

  12. Sprung CL, Artigas A, Kesecioglu J, et al. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderly. Crit Care Med. 2012;40:132–8.

    Article  Google Scholar 

  13. Göranson KE, Ehrenberg A, Ehnfors M. Triage in emergency departments: national survey. J Clin Nurs. 2005;14:1067–74.

    Article  Google Scholar 

  14. Chris M, Grossman F, Winter D, et al. Modern triage in the emergency department. Dtsch Arztebl Int. 2010;107:892–8.

    Google Scholar 

  15. Grossmann FF, Nickel CH, Christ M, et al. Transporting clinical tools to new settings: cultural adaptation and validation of the Emergency Severity Index in German. Ann Emerg Med. 2011;57:257–64.

    Article  Google Scholar 

  16. De Freitas L, Goodacre S, O’Hara R, et al. Interventions to improve patient flow in emergency departments: an umbrella review. Emerg Med J. 2018;35:626–37.

    Article  Google Scholar 

  17. Institute for Healthcare Improvement. Optimizing patient flow: Moving patients smoothly through acute care settings. IHI Innovation Series white paper; 2003. http://www.ihi.org/resources/Pages/IHIWhitePapers/OptimizingPatientFlowMovingPatientsSmoothlyThroughAcuteCareSettings.aspx. Accessed 4 Aug 2019.

  18. Rutherford PA, Provost LP, Kotagal UR, et al. Achieving hospital-wide patient flow. IHI white paper. Cambridge, MA: Institute for Healthcare Improvement; 2017. http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Hospital-wide-Patient-Flow.aspx. Accessed 4 Aug 2019.

  19. Walker K, Ben-Meir M, Dunlop W, et al. Impact of scribes on emergency medicine doctors’ productivity and patient throughput: multicentre randomised trial. BMJ. 2019;364:l121.

    Article  Google Scholar 

  20. Heaton HA, Nestler DM, Lohse CM, et al. Impact of scribes on emergency department patient throughput one year after implementation. Am J Emerg Med. 2017;35:311–4.

    Article  Google Scholar 

  21. Shuaib W, Hilmi J, Caballero J, et al. Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department. Health Informatics. 2017;25:216–24.

    Article  Google Scholar 

  22. Heaton HA, Castaneda-Guarderas A, Trotter ER, et al. Effect of scribes on patient throughput, revenue and patient and provider satisfaction: a systematic review and meta-analysis. Am J Emerg Med. 2016;34:2018–28.

    Article  Google Scholar 

  23. Parkhe M, Myles PS, Leach DS, et al. Outcome of emergency department patients with delayed admission to an intensive care unit. Emerg Med (Fremantle). 2002;14:50–7.

    Article  Google Scholar 

  24. Holst JA, Perman SM, Capp R, et al. Undertriage of trauma-related deaths in the US emergency departments. West J Emerg Med. 2016;17:315–23.

    Article  Google Scholar 

  25. Churpek MM, Wendlandt B, Zadravecz FJ, et al. Association between ICU transfer delay and hospital mortality: a multicenter investigation. J Hosp Med. 2016;11:757–62.

    Article  Google Scholar 

  26. Smith MEB, Chiovaro JC, O’Neil M, et al. Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Ann Am Thorac Soc. 2014;11:1454–65.

    Article  Google Scholar 

  27. Geiderman JM, Malik S, McCarthy JJ, et al. The care of VIPs in the emergency department: triage, treatment and ethics. Am J Emerg Med. 2018;36:1881–5.

    Article  Google Scholar 

  28. Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis. BMC Emerg Med. 2011;11:16.

    Article  Google Scholar 

  29. Bailey R. The case of Dr. Anna Pou: physician liability in emergency situations. Virtual Mentor. 2010;12:726–30. AMA J Ethics.

    PubMed  Google Scholar 

  30. Pou AM. Ethical and legal challenges in disaster medicine: are you ready? South Med J. 2013;106:27–30.

    Article  Google Scholar 

  31. Nates JL. Combined external and internal hospital disaster: impact and response in a Houston trauma center intensive care unit. Crit Care Med. 2004;32:686–90.

    Article  Google Scholar 

  32. Nates JL, Moyer VA. Lessons from Hurricane Katrina, tsunamis, and other disasters. Lancet. 2005;366:1144–6.

    Article  Google Scholar 

  33. Rathi NK, Haque SA, Morales F, et al. Variability in triage practices for critically ill cancer patients: a randomized controlled trial. J Crit Care. 2019;53:18–24.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Charles L. Sprung

Authors
  1. Joseph L. Nates
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  2. Charles L. Sprung
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Corresponding author

Correspondence to Joseph L. Nates .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology and Critical Care, Tettnang Hospital, Medizin Campus Bodensee, Tettnang, Germany

    Andrej Michalsen

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA

    Nicholas Sadovnikoff

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Nates, J.L., Sprung, C.L. (2020). Emergency Medicine and Critical Care Triage. In: Michalsen, A., Sadovnikoff, N. (eds) Compelling Ethical Challenges in Critical Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-43127-3_8

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  • DOI: https://doi.org/10.1007/978-3-030-43127-3_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43126-6

  • Online ISBN: 978-3-030-43127-3

  • eBook Packages: MedicineMedicine (R0)

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