Optimizing Triage and Hospitalisation In Adult General medical Emergency patients: the TRIAGE study

Beat Müller

Sabina De Geest; Alexander Kutz; Eva Grolimund;; Andreas Huber; Thomas Fabbro; Stefanie von Felten; Stefan Felder; Lukas Fässler; Prof. Pasqualina Perrig; Andriy Zhydkov; Philipp Schuetz; Pierre Hausfater; Devendra Amin; Meredith Rosenthal; Barbara Reutlinger; Ulrich Bürgi; Antoinette Conca; Angela Gabela; Petra Tobias; Susanne Schirlo; Ursula Schild; Katharina Regez; Zeljka Caldara; Sebastian Haubitz

Zusammenarbeit mit
University Department of Internal Medicine, University Basel, Kantonsspital Aarau, CH-5001 Aarau; Institute of Nursing Science, University Basel, CH-4056 Basel;Division of Medicine, Hôpital Pitié-Salpétriêre, Paris, France; Morton Plant Hospital, Clearwater, FL, USA; Department of Health Policy and Management, Harvard School of Public Health, Boston, USA; Department of Nursing Science, Kantonsspital Aarau, CH-5001 Aarau; Department of Laboratory Medicine, Kantonsspital Aarau; Clinical trial unit (CTU), University of Basel, Basel; Department of Emergency Medicine, Kantonsspital Aarau, CH-5001 Aarau; Department of Health Economics, University of Basel, Basel; Department of Psychology, University of Berne

2013 bis 2014


Background: Patients presenting to emergency departments (ED) face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal triage. ED triage should focus not only on treatment priority, but also on prediction of medical risk and nursing needs to improve site of care decision and discharge management. Different triage scores have been proposed, such as the Manchester Triage Score (MTS). Yet, these scores focus only on initial treatment priority, have suboptimal performance and lack broad validation. Along with the introduction of the MTS, we propose a comprehensive cohort study to isolate modifiable key factors for an optimized patient triage in the ED, a more structured assessment during hospital stay and prediction of post-acute nursing care needs.

Hypothesis: Improved triage based on the compilation of MTS, vital signs, clinical parameters, blood markers and nursing factors improves early risk stratification and allocation of resources.

Design: International, multicenter, multi-professional prospective, observational, cohort study. 

Patient population: All consecutive medical patients seeking ED care will be included, except non-adult and non-medical patients, i.e., in Aarau 5000 and in France and the US 2500 patients over one year.

Procedures: All procedures are part of usual clinical care. Upon ED admission, a triage nurse will calculate the MTS. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED discharge, the post-acute care discharge score (PACD) score will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge. Patients will be reassessed daily until hospital discharge during the hospital course for medical and nursing stability. To assess outcomes, data from electronic medical records will be used and all patient will be contacted at day 30 after hospital discharge to assess vital status, rehospitalisation and quality of life measures.