Abstract:
Aim: To explore staff perceptions and patient outcomes associated with the use of the Australasian Triage Scale (ATS) in a metropolitan emergency department (ED) in Aotearoa-New Zealand.
Methods: A two-phase, mixed-methods, convergent design (QUAL+QUAN) was employed. Research was conducted at a single ED setting in Aotearoa-New Zealand. In phase one, in-depth interviews of ED Triage Nurses and Emergency Medicine Senior Medical Officers were sought, to explore their perceptions on the use of the ATS in relation to the adult ED population. The interview data were thematically analysed to determine overarching themes. In phase two, a retrospective audit of electronic medical records was used to measure patient outcomes in relation to their ATS category assignment. Patient outcomes were also measured in relation to whether, or not, they had received medical assessment and treatment within the Australasian College of Emergency Medicine’s (ACEM) time-to-treatment timeframes.
Findings: In phase one, 23 in-depth interviews were conducted, generating four over-arching themes: perceptions of the use of the ATS at an organisational; clinical practice; and patient level; and a lack of visibility of the ATS. Numerous barriers to the use of the tool were identified across these themes including: a lack of educational support, large patient volumes, and acuity, and the limited relevance of the tool in practice. Phase two analysed 60,152 presentations to the study ED over a 12-month period. Results showed a parallel trend of increasing rates of hospital admissions, critical care type admissions, and in-hospital deaths with the increasing urgency of the ATS category assigned (p <0.0001). NZ Maaori and Pacific patients were found to be increasingly assigned less urgent ATS categories, while NZ and Other European patients were decreasingly assigned less urgent ATS categories (p <0.0001). Patients who received medical assessment and treatment within ACEM’s time-to-treatment parameters had increased hospital admissions, critical care type admissions and in-hospital deaths (p <0.0001).
Conclusion: Overall, clinicians perceived multiple barriers to the use of the ATS across organisational, clinical practice, and patient levels. Quantitative data supported clinician findings, and identified worse outcomes for patients if they were treated on time. Maaori and Pacific patients were more likely to be assigned a less urgent triage category. Further research is required to understand if this resulted in worse outcomes for these populations.