| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 107 === Purpose The purpose of the study was to compare the difference of the two classification methods bewteen Taiwan Triage And Acuity Scale (TTAS Triage Scale) and the New York University Emergency Department Algorithm (NYUED Algorithm) to explore the appropriateness of emergency patients to provide the reference from the period of providing clinical staff to judge the patient's emergency, follow-up treatment and the forecast of the prognosis.
Method This study is a retrospective study, a sub-database analysis, based on the declaration data of health insurance in a regional teaching hospital in the southern Taiwan and the statistics related to the quality pointer within the hospital. Emergency patient’s characteristics from July to August in 2017 are analyzed to understand the correlation between the progression, the degree of urgency, and the prognosis by the analysis such as descriptiveness and consistency from the SPSS package.
Results This study showed that the majority of the overall cases were level 3 patient (58.5%), with an average age of 55.92, gender is dominated by women (51.3%) with an average declared medical expenses of 13,119.68 NTD, with the majority of the prognosis being discharged and returned home (68%) . Comparison of the two classifications, gender section,TTAS Triage Scale and NYUED Algorithm. The results showed that both the level 1 and 2 patients and the emergency patients were more male than female, while level 3, 4 and 5 patients and non-emergency patients were more female than the male; The majority of patients were below the age of 60 years old in level 3, 4 and 5 patients and non-emergency patients, the majority of patients were over the age of 60 years old in level y 1 and 2 patients and emergency patients; The lower the number of Triage Scale and emergency patients, the higher the declared medical expenses; The lower the number of Triage Scale and emergency patients, the more hospitalization; the most part of the level 3, 4 and 5 patients and non-emergency patients, returned home finally. In the consistency check section, Kappa A value between the TTAS Triage Scale classification system and the NYUED algorithm is 0.065, which is low in consistency, and the sex part is more consistent than female patients in terms of male (P<0.001). The age part,60 to 75 years old and more aged patients have a higher consistency than other age group (P<0.001). The portion of the declared medical expenses, the consistency of the groups below 4,999NTD is higher than that of other medical expenses (P<0.001). In transfer part, the consistency of the returned home group is higher than other (P<0.001). In the analysis section of Triage Scale effectiveness,(1) the results of the Rogis Regression Analysis of the attributes of emergency patients and the risk of discharge from hospital show that the classification of TTAS Triage Scale was conducted. It is difficult to predict whether an emergency patient is leaving hospital or hospitalized, but the NYUED algorithm allows for a more accurate prediction of the appropriateness of a patient's visit (verified with a non-discharge chance) (2) Secondary Triage Scale section: A retrospective re-examination by 2 senior caregivers found that 55% of the number of Triage Scale level can be adjusted, and nearly 60% of the detection and injury severity is overestimated.
Conclusions The classification results of the TTAS Triage Scale and the NYUED algorithm are not consistent. However, classified by the NYUED algorithm as an emergency patient with a higher likely hospitalization, so it can assist clinicians to determine the urgency of the patient's emergency and hospitalization. Since April 2017, the Health Insurance Department has increased the selfburden of patients who have been classified as the levels 1, 2 and 3 in emergency medical centres, may cause the impact of medical access to some of the more serious patients with level 3 Triage Scale.
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