Implementation of the Individual Danish Emergency Process Triage

Study Overview
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Brief Summary
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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
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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.

Official Title
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Implementation of the Individual Danish Emergency Process Triage (I-DEPT)

Conditions
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Acute Disease, Emergencies, Clinical Syndrome

Intervention / Treatment
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* Other: I-DEPT
* Other: DEPT


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 17 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Stepped-Wedge cluster randomized design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: I-DEPT<br>Novel triage. The triage nurse can adjust the triage category one level of urgency down or one or two levels up. | Other: I-DEPT<br>* Implementation of the novel triage algorithm<br>|
| Active Comparator: DEPT<br>Existing triage algorithm | Other: DEPT<br>* Existing triage algorithm<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 30-day mortality | All cause mortality within 30 days following triage in the index admission by non-inferiority | 30 days | 

Secondary Outcome Measures

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

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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triage, risk stratification, emergency department