Early use of admission triage score in the emergency department to prevent crowding

Nottingham University Hospitals NHS Trust

  • Led by Nottingham University Hospitals NHS Trust.
  • Implemented with all non-injury-related adult attendances at the Trust’s Emergency Department, and aimed to improve patient and staff satisfaction and reduce length of stay, unnecessary investigations, admissions and crowding.
  • Trialled an admission prediction tool that uses a scoring system to identify both patients who are likely to be admitted and those likely to be discharged.
  • Project ran from September 2016 to November 2017.

Emergency departments are continuing to see a rise in attendances. The resulting crowding contributes to prolonged length of stay and poor patient experience. Late decision making or delayed senior involvement is thought to contribute to crowding.

This project looked at how best to direct the workload of senior clinicians to maximise their clinical time, prioritise and streamline workload, and prevent crowding.   

It involved using a prediction tool, devised in Glasgow, which identifies patients who are likely to be admitted or discharged. 

In a trial of the system, it was applied to all adult non-injury cases attending the emergency department at Nottingham University Hospitals NHS Trust between May and September 2017, which amounted to more than 50,000 patients. The time the score generated and the time a real decision to admit was applied to a patient were compared – this showed that if the score had been used as a decision to admit, the decision would have been made an average of 2.5 hours earlier.

This earlier identification of patients who are likely to be admitted means cases can be highlighted to hospital bed managers, allowing for better planning and flow. Identifying those who are likely to be discharged means these cases can be highlighted to senior clinicians, and rapid assessment and treatment can be undertaken.

The main challenge was around improving the predictive accuracy of the score, as some concerns were raised about increasing admission rates. Work is continuing to improve its accuracy before it can be embedded into practice.

Contact information

For more information about this project, please  Dr Ben Pope, Consultant Emergency Physician and Service Improvement Lead for Emergency Department, Nottingham University Hospitals NHS Trust.

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