The American journal of emergency medicine · 2025
Emergency department triage associated with timeliness of care for patients with septic shock.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Sax Dana R, Warton E Margaret, Mark Dustin G, Rauchwerger Adina S, DiLena Daniel D, Reed Mary E
Аннотация
STUDY OBJECTIVE: Among emergency department (ED) patients with septic shock, assess the association between high- versus low-priority triage assignment on delays in care.
METHODS: Retrospective cohort study of ED encounters from 2016 to 2020 across 21 community EDs. All EDs used the Emergency Severity Index (ESI) to triage patients. Patients were included if they had an ED or hospital diagnosis of septic shock and received intravenous antibiotics and vasopressors in the ED. Patients were categorized as receiving a high- (ESI I or II) versus low- priority triage assignment (ESI III - V). Outcomes included four measures of timeliness of care and 30-day mortality.
RESULTS: Among 8601 patient encounters; median age was 71.0, 4452 (51.8 %) were male and 1159 (13.5 %), 887 (10.3 %), 4611 (53.6 %), 1287 (15.0 %), and 657 (7.6 %) were Asian, Black, Non-Hispanic White, Hispanic, and other, respectively. We found 7071 (82.2 %) patients received a high-priority triage assignment. The mean adjusted differences between high- and low-priority patients in initial orders, antibiotic delivery, vasopressor delivery, and ED length of stay were 4.6 min (95 % CI 4.2-4.9 min), 34.4 min (95 % CI 31.0-37.8 min), 27.5 min (95 % CI 25.5 min - 29.5 min), and 51.6 min (95 % CI 44.8 min - 58.2 min), respectively. The mean adjusted 30-day mortality rates among high- and low-priority triage patients were 36.3 % (95 % CI 24.5% - 53.8 %) and 32.7 % (21.9 % - 48.9 %), respectively.
CONCLUSION: Lower triage priority is associated with delays in care for patients with septic shock. Early identification is critical to ensure timely care and improved outcomes.
METHODS: Retrospective cohort study of ED encounters from 2016 to 2020 across 21 community EDs. All EDs used the Emergency Severity Index (ESI) to triage patients. Patients were included if they had an ED or hospital diagnosis of septic shock and received intravenous antibiotics and vasopressors in the ED. Patients were categorized as receiving a high- (ESI I or II) versus low- priority triage assignment (ESI III - V). Outcomes included four measures of timeliness of care and 30-day mortality.
RESULTS: Among 8601 patient encounters; median age was 71.0, 4452 (51.8 %) were male and 1159 (13.5 %), 887 (10.3 %), 4611 (53.6 %), 1287 (15.0 %), and 657 (7.6 %) were Asian, Black, Non-Hispanic White, Hispanic, and other, respectively. We found 7071 (82.2 %) patients received a high-priority triage assignment. The mean adjusted differences between high- and low-priority patients in initial orders, antibiotic delivery, vasopressor delivery, and ED length of stay were 4.6 min (95 % CI 4.2-4.9 min), 34.4 min (95 % CI 31.0-37.8 min), 27.5 min (95 % CI 25.5 min - 29.5 min), and 51.6 min (95 % CI 44.8 min - 58.2 min), respectively. The mean adjusted 30-day mortality rates among high- and low-priority triage patients were 36.3 % (95 % CI 24.5% - 53.8 %) and 32.7 % (21.9 % - 48.9 %), respectively.
CONCLUSION: Lower triage priority is associated with delays in care for patients with septic shock. Early identification is critical to ensure timely care and improved outcomes.