The association of triage scale with emergency intervention as well as medical expenditure at emergency department

• Main Authors: CHIEN,YI-CHUN, 簡義君
• Other Authors: CHEN,CHU-CHIEH
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/a4d798

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 106 === Background: Triage systems have to identify patients who need immediate attention on one hand but also to recognize patients who can safely wait or may not need emergency care at all on the other hand. Although a variety of triage and acuity scales are widely used in the emergency department（ED）, relevant studies using nation-based data on triage are still few in Taiwan. Objectives: This study aims to evaluate the association of Taiwanese triage acuity scale with emergency intervention at ED, and medical expenditures at ED. Methods: This is a cross-sectional population-based study using data of one million people randomly selected, from National Health Insurance Data (NHID) in year 2010, using SAS 9.4 statistical package software to conduct data analysis and statistical analysis. First of all, descriptive statistics was analyzed to discuss Taiwan emergent patients’ basic characteristics, health conditions, and medical records. Then, relevant factors on the levels of emergency triage, emergency intervention, and medical expenditures were examined through the test of homogeneity (χ2 test), the Chi-Squared Test of Independence (χ2 test), Scheffe’s method, linear regression analysis, and logistic regression. A p-value of <0.05 was considered as statistically significant for the present study. Results: The number of Taiwan emergency patients in 2012 is 138,713. Firstly, there was a significant correlation between TTAS score and the adjusted odds of immediate life-saving intervention（p<0.05）. Compared with patients in TTAS 3, the adjusted odds ratios for immediate life-saving intervention were 68.33 （95% CI =64.48 to 74.72）, 7.17（95% CI =6.72 to 7.64）,0.35（95% CI =0.31 to 0.41）, and 0.48（95% CI =0.31 to 0.75）for patients in TTAS 1, 2,4, and 5, respectively. Secondly ,there was a significant correlation between TTAS score and the adjusted odds of computerized tomography（CT scan）（p<0.0001）.Compared with patients in TTAS 3, the adjusted odds ratios for CT scan were 2.52（95% CI =2.31 to 2.74）, 2.23（95% CI =2.13 to 2.34）, 0.32（95% CI =0.29 to 0.34）, and 0.24（95% CI =0.18 to 0.33）for patients in TTAS 1, 2,4, and 5, respectively. Thirdly ,there was a significant correlation between TTAS score and the adjusted odds of specialist consultation（p<0.0001）.Compared with patients in TTAS 3, the adjusted odds ratios for 1.93（95% CI =1.75 to 2.12）, 1.74（95% CI = 1.65 to 1.84）, 0.60（95% CI =0.57 to 0.64）, and 0.47（95% CI =0.37 to 0.59）for patients in TTAS 1, 2,4, and 5, respectively. Finally, the average medical expenditures show that compared with TTAS level 5, levels 1, 2, 3, and 4 are increased by NTD 6604.847, NTD 3425.466, NTD 1173.964, and NTD 441.593 , respectively, which are all statistically significant (p<0.0001). Conclusion: The main finding of the present study is that emergency intervention (such as immediate life-saving intervention, specialist consultation, and CT scan) and emergency medical expenditures gradually decrease by the increase of the levels of emergency triage.