Physician gestalt for emergency department triage: A prospective videotaped study

摘要

Abstract Objective Appropriate triage in patients presenting to the emergency department (ED) is often challenging. Little is known about the role of physician gestalt in ED triage. We aimed to compare the accuracy of emergency physician gestalt against the currently used computerized triage process. Methods We conducted a prospective observational study in the ED at an academic medical center. Adult patients aged ≥20?years were included and underwent a standard triage protocol. The patients underwent system‐based triage using the computerized software the Taiwan Triage and Acuity Scale. The entire triage process was recorded, and triage data were collected. Five physician raters provided triage levels (physician‐based) according to their perceived urgency after reviewing videos. The primary outcome was hospital admission. The secondary outcomes were ED length of stay (EDLOS) and charges. Results In total, 656 patients were recruited (mean age?52?years, 50% male). The median system‐based triage level was 3. By contrast, the median physician‐based triage level was 4. The physician raters tended to provide lower triage levels than the system, with an average difference of 1. There was modest concordance between the two triage methods (correlation coefficient?0.30), with a weighted kappa coefficient of 0.18. The area under the receiver operating curve for the system‐ and physician‐based triage in predicting hospital admission were similar (0.635 vs. 0.631, p?=?0.896). Attending physicians appeared to have better performance than residents in predicting admission. The variation explained (R2) in EDLOS and charges were similar between the two triage methods (R2?=?3% for EDLOS, 7%–9% for charges). Conclusions Emergency physician gestalt for triage showed similar performance to a computerized system; however, physicians redistributed patients to lower triage levels. Physician gestalt has advantages for identifying low‐risk patients. This approach may avoid undue time pressure for health care providers and promote rapid discharge.