Quality of Emergency Room Triage of Medical Inpatients to an Acute Care Clinic or Chronic Health Care Facilities

Objective: To evaluate the accuracy of emergency room triage by general internists assigning medical patients to four different health care settings.

Design: Prospective trial.

Setting: Medical emergency room of a university hospital providing primary and referral care.

Patients: 974 consecutive patients admitted for acute medical care, excluding patients admitted to intensive care units.

Intervention And Measurements: After primary evaluation patients were assigned to one of four groups: A) acutely ill requiring acute care in a general medical ward (n = 598); B) acutely ill requiring acute care limited to two to three days (n = 201); C) chronically ill with realistic chances for rehabilitation (n = 77); and D) chronically ill requiring definite referral to skilled nursing home care (n = 98). Nine months later, outcome and placement after index hospitalization were evaluated in surviving patients.

Main Results: 159 (16%) patients died; three (1%) were lost to follow-up. Evolution confirmed the appropriateness of the initial triage of 90% of the remaining 812 patients (83%). Allocations were correct in 96%, 95%, and 91% of cases in groups A, B, and C, respectively. In group D, only 44% were definitely transferred to nursing homes; 56% were rehabilitated and returned to their previous social settings or entered homes for the aged.

Conclusions: Clinical judgment of general internists in an emergency room adequately identifies patients requiring acute care of regular or short duration and chronically ill patients with realistic prospects for rehabilitation. But the need for nursing home placement is overestimated. To avoid patient misplacement the authors propose direct access to a specialized geriatric assessment facility.