How A&E Triage Helps Hospitals Prioritise Admissions

Patients may visit A&E for a variety of reasons. Some come seeking advice, while others require admission due to serious illness.

A&E departments are essential points of entry into the health and social care system. Due to high demand, they must deliver services quickly and efficiently.

Symptoms

A&E departments are equipped to handle a wide range of emergency situations, such as fractures, chest pain, infections and more. Unfortunately, many patients present to A&E without needing an admission.

At A&E, patients are triaged, examined and given a working diagnosis. After that, they may either be transferred to a ward or released from the hospital.

Patients admitted to A&E departments can present with a variety of symptoms, from minor to serious. While some are seen by specialists, most receive more generalized care from nursing staff.

Doctors could spend more time with patients, which may enable them to diagnose the issue sooner and provide appropriate treatment. It could also reduce the likelihood that patients develop complications or need secondary care referrals.

This study sought to investigate a wide range of complaints presented by patients admitted to an A&E department in PGHK from 12th March until 30th April 2019. Data collection was done using a paper-based data sheet which was filled out daily by an admitting nursing officer.

In total, 49,213 patients were admitted to PGHK’s A&E department during the study period. Most of these admissions were self-referred (in person or via phone), with transfers from hospitals and referrals by general practitioners making up a smaller share.

Chest pain was the most frequent complaint, followed by chest discomfort and other conditions like slurring of speech, dizziness or giddiness, dyspnoea and vomiting.

Abdominal pain was the most frequent complaint seen among pediatric patients and adults visiting A&E.

At PGHK’s A&E department, the majority of patients were male and the mean age was 46.7 years. There was a higher proportion of medical, surgical and paediatric admissions compared to gynaecological and obstetric ones.

Triage

Triage is the process of assessing the severity and urgency of a patient’s illness or injury. It helps hospitals prioritize patient admissions, guaranteeing critically ill patients receive priority attention while making efficient use of space and resources.

Triage, from French, means “sort.” It is commonly used in emergency rooms to prioritize medical priorities for patients. This process is especially crucial during mass casualties caused by war zones or disasters when limited resources must be allocated to the most seriously injured.

Triage nurses assess a patient’s symptoms to determine if they need immediate treatment in the emergency department or can be treated at home. In some cases, nurses may provide care over the phone by listening to patients’ complaints and determining their need for urgent attention.

Triage nurses play an essential role in keeping the emergency department running efficiently, and their work is affected by various factors. To be successful, these professionals must receive appropriate training and possess excellent communication abilities with physicians and other healthcare workers.

When a patient arrives in the emergency room, they will be welcomed by a triage nurse who will assess their symptoms, medical history and vital signs to determine whether or not medical intervention is necessary.

Once they have assessed a patient’s level of need, they will direct them to an appropriate area within the emergency department. This may include emergency medicine clinic, pediatrics, general surgery or neurology.

In addition to assessing a patient’s level of need, the triage nurse must take into account available hospital bed space and the admission team in order to decide which beds can be allocated optimally in order to care for all patients equally.

Implementing a systematic triage process can help hospital staff manage their workload more effectively, thus improving patient safety. In the emergency department, for instance, proper triage can prevent undertriage (underestimation of patient urgency or severity), leading to delays in care and prolonging the workup process. Furthermore, an undertriage rate may cause patients to stay longer than necessary in the hospital, wasting resources and increasing costs to the health care system.

Waiting time

Waiting time for hospital admissions is a common issue among patients and healthcare providers alike, as it can be an obstacle to accessing health services and lead to poorer outcomes. In the UK, the four-hour A&E waiting time target has become one of the key objectives in healthcare policy; set out in the Handbook to the NHS Constitution at 95% admission, transfer or discharged within four hours after arrival.

However, waiting times can be prolonged for various reasons. These include changes in bed availability and staff availability. Delays during transfers between A&E departments and hospital wards may also cause issues. The National A&E Transfer Policy outlines several strategies hospitals can improve their performance at meeting the four-hour target, such as decreasing delays and improving access to hospital services.

Referred patients to emergency departments can experience a lengthy wait time between referral and starting point of treatment. This is often because it’s impossible to pinpoint exactly when they were first seen or what diagnosis they had, making measuring this waiting period challenging.

In the UK, VENTSYS, a national system for measuring waiting time, uses hospital reports to track this process. Figure 1 displays the waiting time from the beginning of a treatment period until an admission into hospital.

A more transparent measurement of waiting times could give us insight into why they differ and lead to more effective intervention strategies, improving patients’ experiences within the healthcare system.

There are other factors which can contribute to the length of time patients stay in hospital. Age and gender, for instance, can both influence how quickly a patient will receive medical attention.

Furthermore, socioeconomic status has an impact on waiting times. Generally, those from lower socioeconomic status households tend to face longer waits due to having less education and low incomes. Therefore, further research is necessary into how SES affects waiting times.

Discharge

Once medical professionals have determined that a patient is ready to leave hospital, they should create and distribute a discharge plan to both them and any caregivers or relatives. Ward staff can also offer assistance with creating this document; this could include arranging someone to pick them up at home or offering advice on what support services might be provided after they depart.

Discharge can help reduce readmissions and hospital costs, but it must be done promptly. Unfortunately, many patients who should leave hospital stay longer than necessary – leading to additional bed days that cost the NHS money.

If you are leaving hospital, make sure that you receive a copy of your discharge plan and all pertinent information on where and when to get help after you depart. This includes any medication necessary and care requirements. Additionally, there should be an organized list of organisations you can reach for additional support if needed.

Within seven to 10 days after discharge, make sure that any issues that arose while in hospital are addressed and your health continues to improve.

Depending on your condition, you may require to continue receiving care in a specialist community setting or at home after leaving hospital. This could involve returning to the care home where you were prior to admission or beginning a care package with an area care agency.

Discharge planning should begin upon admission for planned admissions and 24- hours before discharge for unplanned admissions. Doing this allows the ward to allocate resources ahead of time and guarantee optimal bed assignments.

Discharge planning can be a challenging process as it involves coordinating the care of multiple individuals. To ensure optimal outcomes for patients and healthcare systems alike, this requires an organized multidisciplinary approach supported by sophisticated technology.