Triage

Triage Definitions : The Australasian Triage Scale (ATS) is a nationally accepted scale used to categorise patients :

DESCRIPTION OF ATS SCALE – Source : ACEM Policy & Guidelines on ATS (Issued in 2000 & Reviewed in 2006 – no changes)

ATS CATEGORY TREATMENT ACUITY
(Maximum waiting time)
 The waiting time is typically measured
from the time a triage category is allocated
by the Triage Nurse to when the patient
receives “active treatment“.
(some data integrity problems in 2008)
– NSW Health
PERFORMANCEINDICATOR

THRESHOLD

ATS 1 ( Note – Canadian Resuscitation ) Immediate 100%
ATS 2 ( Note – Canadian Emergency ) 10 minutes 80%
ATS 3 ( Note – Canadian Urgent ) 30 minutes 75%
ATS 4 ( Note – Canadian Semi -Urgent ) 60 minutes 70%
ATS 5 ( Note – Canadian Nonurgent ) 120 minutes 70%

In response to the ACEM introduction of the ATS system, in 2001, the Emergency Nurses Association of NSW Inc recommended the following changes (bold underline) :

  • ATS 1 Immediate 100%
  • ATS 2 10 minutes 95%
  • ATS 3 30 minutes 90%
  • ATS 4 60 minutes 90%
  • ATS 5 120 minutes 85%

In 2012 National Healthcare Agreement – recommendations by ACEM – that 80% of ED presentations seen within the clinically recommended times for varous ATS scales.
Refer to MyHospital Website for ED Waiting Time performance – historical data
Refer 2011 – UOW Study for COAG by Prof K Eagar et al on ED Performance across Australia – categorised according to ATS 1 to 5 by State & overall Australian data

{Note – Triage Education Kit – Appendix B & Appendix E give details ATS Scale definitions & examples}

Key Questions for Alternative Approach – viz to move ATS 4 & ATS 5 out of ED’s to reduce pressure

  • Are Hospital Emergency Departments seeing too many “inappropriately presenting to ED” Category ATS4 & ATS5 patients ?

Answer in this ACEM – 2001 study was No – not the case in 2001 – (note – but what about since then?)

  • Could an extended 24 Hour GP Clinic to address ATS 4 & ATS 5 be financially viable ?

Answer in this ACEM – 2001 study was No – a Financially Challenging Proposition : with the following issues (note – any changes to these circumstances since 2001 ?)

  • Lifestyle Choices
  • Level of Rebate for After Hours Attendances
  • No “on-call” payments
  • Need to bulk bill to avoid bad debts
  • No payment for telephone consults
  • Personal Safety Issues

In 2009 it was scheduled to carry out an Australian Triage Process Review Project in 2010 as it was believed that ED situations had changed over the last 15 years :

  • the growth in the number of patients attending EDs,
  • the introduction of different ways of doing things within EDs eg Fast Track zones, use of waiting room nurses
  • improvements to patient safety
  • the changing access to mental health services
  • the changed availability of general practice services
  • increased skill levels of ambulance paramedics
  • the introduction of the Health Direct 24/7 call line.
  • the introduction of new technologies in Health and the treatment of some conditions

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