Implementation of the Individual Danish Emergency Process Triage

Not Applicable

Completed

• Conditions: Acute Disease; Clinical Syndrome; Emergencies
• Interventions: Other: I-DEPT; Other: DEPT

• Registration Number: NCT04571021
• Lead Sponsor: Herlev Hospital

Brief Summary

The purpose of the study is to implement and evaluate a novel triage algorithm for risk stratification of acutely admitted patients in the Emergency Department.

Detailed Description

Triage algorithms are used worldwide to risk assess and prioritize patients in the Emergency Departments. The aim is to identify patient at risk of deterioration or death and/or with a imminent need of treatment. The triage algorithms are also developed to identify patients at low risk, who safely can be assigned to the waiting room.

Currently, several different triage algorithms are used, and they are mostly based on consensus and exper- opinion. Therefore evidence concerning triage is limited.

The investigators has developed a novel evidence-based triage algorithm with integrated individual clinical assesment. The vitals measured at admission assigns the patient to a triage category, and based upon the clinical appearance of the patients, the triage nurse can adjust the assigned triage category to better reflect the patient. The triage algorithm used in Denmark is "DEPT", this algorithm is based purely on vitals and cause of admission and can not be adjusted.

I-DEPT is designed as a cluster randomized stepped-wedge non-inferiority study. The Aim is to implement and compare I-DEPT to the existing triage algorithm. All Emergency Departments in the Capitol Region and the Region og Zealand in Denmark will implement I-DEPT one department at a time (8 centers). The first will start the implementation on october 1, 2020 and after two months the next center will implement I-DEPT. Every two months a new center will start. During 16 months all centers will have implemented I-DEPT the sequence of centers was determined by randomization. The first 30 days of implementation will be censored and not included in the final analyses. The study will conclude with a period of 30 days follow-up. Patients will only be included once.

Study Timeline

• Study First Submitted: 2020-09-24
• Study First Submitted QC: 2020-09-29
• Study First Posted: 2020-09-30
• Study Start: 2020-10-01
• Primary Completion: 2022-05-01
• Study Completion: 2022-05-01
• Status Verified: 2023-03
• Last Update Submitted: 2023-03-30
• Last Update Posted: 2023-04-03

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 250000

Inclusion Criteria

• Admission to a participating Emergency Department in the study period
• Full triage assesment in the index admission

Exclusion Criteria

• Age below 17 years
• Death at arrival or before triage assesment

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
I-DEPT	I-DEPT	Novel triage. The triage nurse can adjust the triage category one level of urgency down or one or two levels up.
DEPT	DEPT	Existing triage algorithm

Primary Outcome Measures

Name	Time	Method
30-day mortality	30 days	All cause mortality within 30 days following triage in the index admission by non-inferiority

Secondary Outcome Measures

Name	Time	Method
2-day mortality	2 days	All cause mortality within 2 days following triage in the index admission
Patients in the orange triage category	1 day	Number of patients assigned to the orange category
Time in the Emergency Department	30 days	Time spent in the Emergency department from triage to either admission, transfer or discharge
Distribution of triage categories	1 day	There are four categories in both triage algorithms used in this study: (green (least urgent), yellow, orange, and red (most urgent))
Doctor assessment	1 day	Time from triage to arrival of a doctor
Patients left without being seen	30 days	Number of patients leaving the Emergency Department without being assessed by a doctor
Days in hospital	30 days	The number of days admitted to a hospital within 30 days

Trial Locations

Locations (8)

Slagelse Hospital; 🇩🇰 Slagelse, Denmark

Herlev and Gentofte hospital; 🇩🇰 Herlev, Capital Region, Denmark

Bispebjerg and Frederiksberg hospital; 🇩🇰 Copenhagen, Denmark

Nordsjællands Hospital; 🇩🇰 Hillerød, Denmark

Holbæk hospital; 🇩🇰 Holbæk, Denmark

Hvidovre, Amager and Glostrup Hospital; 🇩🇰 Hvidovre, Denmark

Sjælland University hospital; 🇩🇰 Køge, Denmark

Nykøbing Falster Hospital; 🇩🇰 Nykøbing Falster, Denmark