Development a Reverse Triage System Based on Modified Sequential Organ Failure Assessment for Increasing the Critical Care Surge Capacity

Enhancing Disaster surge capacity through reverse triage in Addis Ababa Ethiopia: A retrospective cross-sectional study

BACKGROUND

During disasters and emergencies, hospitals play a pivotal role in response efforts, particularly through the early discharge of inpatients who can be safely discharged to free up capacity. Reverse triage helps hospitals allocate resources efficiently and prioritize patient care according to medical necessity.

OBJECTIVE

To investigate the impact of reverse triage on the surge capacity of public hospitals in Addis Ababa, Ethiopia.

METHODS

This cross-sectional study was conducted in three public hospitals using convenience sampling. Data were collected from September 1 to 30, 2023. Descriptive statistics and binomial logistic regression were used to identify factors associated with hospital surge capacity.

RESULTS

A total of 296 participants were included, of whom 45.9 % were aged 13-34 years and 55 % were female. Of the participants, 69.3 % were admitted through the Emergency Department. The Reverse Triage Tool Leuven was used to assess patients for early discharge, with 58.4 % (95 % CI 52.6 %-64.1 %) qualifying. The percentage of patients eligible for early discharge was approximately 66.7 % (95 % CI 54 %-77.8 %) at Zewditu Memorial Hospital, 57.6 % (95 % CI 49.5 %-65.4 %) at Tikur Anbessa Specialized Hospital (TASH), and 52.8 % (95 % CI 40.7 %-64.7 %) at St. Paul Hospital, Millennial Medical College. Data indicates that obstetric patients have a significantly higher likelihood of early discharge (p = 0.008) with an Adjusted Odds Ratio (AOR) of 12.62 (95 % CI: 3.978-19.147), making them over 12 times more likely to be discharged early than those in medical units. Similarly, psychiatric patients also exhibit a significant early discharge association (p = 0.002) with an AOR of 6.62 (95 % CI: 3.978-9.147), indicating over six times greater likelihood compared to medical patients. Additionally, the age group 35-44 shows a significant relationship with early discharge (p = 0.027), increasing odds by 26 % per year of age. Surgical units also demonstrate a strong association with early discharge (p < 0.001).

CONCLUSION

This study highlights the effectiveness of reverse triage in identifying patients suitable for early discharge during disasters, thereby enhancing surge capacity and resource management in public hospitals. The regression analysis findings indicate that obstetric and psychiatric units significantly influence early discharge rates among hospitalized patients. This has crucial implications for hospital policies focused on optimizing bed usage and enhancing discharge protocols amid rising healthcare demands and resource constraints.

Surge Capacity Crisis and Mitigation Plan in Trauma Setting Based on Real-Time National Trauma Registry Data

BACKGROUND

The objective of this study was to assess the current breaking point of crisis surge capacity of trauma services in Qatar and to develop a mitigation plan.

METHODS

The study utilized real-time data from the National Trauma Registry. Data was explored cumulatively by weeks, months and a year's interval and all trauma admissions within this time frame were considered as 1 'Disaster Incident.'

RESULTS

A total of 2479 trauma patients were included in the study over 1 year. The mean age of patients was 31.5 ± 15.9 and 84% were males. The number of patients who sustained severe trauma which necessitated Level 1 activation was 16%. The emergency medical services (EMS) surge attained crisis of operational capacity at 5 months of disaster incident for priority 1 cases. Bed capacity at the floor was the first to reach operational crisis followed by the ICU and operating room. The gap in the surge for surgical interventions was specific to the specialty and surgery type which reached operational crisis at 3 months.

CONCLUSION

The study highlights the surge capacity and capability of the healthcare system at a Level 1 trauma center. The identified gaps in surge capacity require several key components of healthcare resources to be addressed across the continuum of care.