The purpose of the study is to implement and evaluate a novel triage algorithm for risk stratification of acutely admitted patients in the Emergency Department.
Triage algorithms are used worldwide to risk assess and prioritize patients in the Emergency Departments. The aim is to identify patient at risk of deterioration or death and/or with a imminent need of treatment. The triage algorithms are also developed to identify patients at low risk, who safely can be assigned to the waiting room. Currently, several different triage algorithms are used, and they are mostly based on consensus and exper- opinion. Therefore evidence concerning triage is limited. The investigators has developed a novel evidence-based triage algorithm with integrated individual clinical assesment. The vitals measured at admission assigns the patient to a triage category, and based upon the clinical appearance of the patients, the triage nurse can adjust the assigned triage category to better reflect the patient. The triage algorithm used in Denmark is "DEPT", this algorithm is based purely on vitals and cause of admission and can not be adjusted. I-DEPT is designed as a cluster randomized stepped-wedge non-inferiority study. The Aim is to implement and compare I-DEPT to the existing triage algorithm. All Emergency Departments in the Capitol Region and the Region og Zealand in Denmark will implement I-DEPT one department at a time (8 centers). The first will start the implementation on october 1, 2020 and after two months the next center will implement I-DEPT. Every two months a new center will start. During 16 months all centers will have implemented I-DEPT the sequence of centers was determined by randomization. The first 30 days of implementation will be censored and not included in the final analyses. The study will conclude with a period of 30 days follow-up. Patients will only be included once.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
250,000
Herlev and Gentofte hospital
Herlev, Capital Region, Denmark
Bispebjerg and Frederiksberg hospital
Copenhagen, Denmark
Nordsjællands Hospital
Hillerød, Denmark
Holbæk hospital
Holbæk, Denmark
30-day mortality
All cause mortality within 30 days following triage in the index admission by non-inferiority
Time frame: 30 days
2-day mortality
All cause mortality within 2 days following triage in the index admission
Time frame: 2 days
Distribution of triage categories
There are four categories in both triage algorithms used in this study: (green (least urgent), yellow, orange, and red (most urgent))
Time frame: 1 day
Patients in the orange triage category
Number of patients assigned to the orange category
Time frame: 1 day
Doctor assessment
Time from triage to arrival of a doctor
Time frame: 1 day
Days in hospital
The number of days admitted to a hospital within 30 days
Time frame: 30 days
Time in the Emergency Department
Time spent in the Emergency department from triage to either admission, transfer or discharge
Time frame: 30 days
Patients left without being seen
Number of patients leaving the Emergency Department without being assessed by a doctor
Time frame: 30 days
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Hvidovre, Amager and Glostrup Hospital
Hvidovre, Denmark
Sjælland University hospital
Køge, Denmark
Nykøbing Falster Hospital
Nykøbing Falster, Denmark
Slagelse Hospital
Slagelse, Denmark