EmergenciesTRIAGENCT01768494
Optimizing Triage and Hospitalisation In Adult General Medical Emergency Patients: the TRIAGE Study
An observational study of Emergencies, run by University Hospital, Basel, Switzerland at 1 site in Switzerland.
Trial summary
Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal initial triage. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Emergencies
- How many people
- 7,000 participants
- Where
- 1 siteSwitzerland
- Study dates
- Mar 2013to Oct 2014
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: All consecutive medical patients seeking ED care will be included. There will be no exclusions except for non-adult and non-medical patients. We expect to include 5000 - 8000 patients over one year of recruitment.
Who may be able to join
- All consecutive medical patients seeking ED care
Who cannot join
- age below 18 years
Trial locations and contacts
1 site in 1 country.
Switzerland1 site
University Clinic, Kantonsspital Aarau
Aarau, Canton of Aargau, 5000
About this study
Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal initial triage. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site of care decision and to simplify early discharge management. Herein, we propose a large prospective cohort study to optimize initial patient triage for (a) better determination of initial treatment priority, (b) overall risk and need for inhospital treatment and (c) early assessment of post-acute nursing needs.
Read the detailed description
Background: Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal initial triage. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site of care decision and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester Triage Score (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss Health care system. Because the MTS will be introduced into clinical routine of the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for inhospital treatment; (c) post-acute care needs of patient's at the most proximal time point of ED admission.
Methods / Design: Prospective, observational, cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED discharge, the post-acute care score will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of discharge. Patients will be reassessed daily during the hospital course for medical and nursing stability. To assess outcomes, data from electronic medical records will be used and all patient will be contacted 30 days after hospital admission to assess vital status, rehospitalisation and quality of life measures.
We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for inhospital treatment and (c) care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, length of hospital stay, patient's satisfaction with care and overall hospital costs.
Discussion: Using a reliable initial triage system for estimating initial treatment priority, need for inhospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted management of medical patients in the ED. Our group has proven feasibility with a track record of several completed and ongoing trials. The proposed interdisciplinary project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient's outcomes in terms of mortality, rehospitalisation, quality of life and satisfaction with care.
- Conditions
- Emergencies
- Medical subject headings
- Emergencies
What is being measured
The primary outcome is the main question the study is designed to answer.
Initial triage priority
Initial triage priority adjudicated by the attending ED physician. Attending ED physicians will classify all patients at ED discharge as either high triage priority or low triage priority in respect to the time patients need to be seen by a physician based on all available information at ED discharge
Measured: within 30 days
Adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission
Adverse 30 day outcome (death or intensive care unit admission) within the hospital stay and within 30 days following ED admission
Measured: Within 30 days of ED admission
Care needs after hospital discharge
Care needs after hospital discharge will be defined as transfer of patients to a post-acute care institution (i.e. transition to a nursing home and others).
Measured: Within 30 days
Secondary outcomes (4)
Time to first physician contact
Time to first physician contact as assessed in the nursing chart; we will investigate this endpoint stratified by patient risk, i.e. we will compare time to first physician contact in high-triage-priority and low-triage-priority patients and stratified by different diagnoses.
Measured: Within 30 days
Time to initiation of adequate medical therapy
Time to initiation of adequate medical therapy in predefined subgroups (e.g., antibiotic therapy for infections, door to needle time for myocardial infarction; early goal directed therapy in sepsis patients, pain relief medication in patients presenting with pain, blood pressure control in patients with a hypertensive crisis); we will further assess time to discharge from the ED to the ward.
Measured: Wihtin 30 days
Satisfaction with care
Satisfaction with care as assessed with a systematic questionnaire in the day 30 telephone interview
Measured: Within 30 days
Hospital costs
Overall hospital costs as assessed by the electronic medical records
Measured: Within 30 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Jan 2013 (estimated)
- Study startMar 2013
- Primary completionOct 2014
- Study completionOct 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (9)Papers the sponsor has linked to this study.
- Other trials for EmergenciesStudies of the same condition, open and under way.
- More trials run by University Hospital, Basel, SwitzerlandThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 7,000 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Hospital, Basel, Switzerland
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Philipp Schuetz, University Hospital, Basel, Switzerland
- Investigators
- Philipp Schütz, PD Dr. med., Principal investigator, Medical University Clinic, Kantonsspital Aarau, Switzerland
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01768494
- Sponsor's protocol ID
- TRIAGE-1
- Acronym
- TRIAGE
- Status last verified
- Dec 2014
- First submitted
- 9 Jan 2013
- Last updated
- 12 Dec 2014
- Results posted
- No
- Data monitoring committee
- No
Publications
Haag E, Gregoriano C, Molitor A, Kloter M, Kutz A, Mueller B, Schuetz P. Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study. Clin Chem Lab Med. 2021 Jan 14;59(6):1165-1176. doi: 10.1515/cclm-2020-1566. Print 2021 May 26.
PubMed 33554514Eckart A, Hauser SI, Kutz A, Haubitz S, Hausfater P, Amin D, Amin A, Huber A, Mueller B, Schuetz P. Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study. BMJ Open. 2019 Jan 17;9(1):e024636. doi: 10.1136/bmjopen-2018-024636.
PubMed 30782737Eckart A, Hauser SI, Haubitz S, Struja T, Kutz A, Koch D, Neeser O, Meier MA, Mueller B, Schuetz P. Validation of the hospital frailty risk score in a tertiary care hospital in Switzerland: results of a prospective, observational study. BMJ Open. 2019 Jan 15;9(1):e026923. doi: 10.1136/bmjopen-2018-026923.
PubMed 30647051Kutz A, Struja T, Hausfater P, Amin D, Amin A, Haubitz S, Bernard M, Huber A, Mueller B, Schuetz P; TRIAGE study group. The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study. Diabet Med. 2017 Jul;34(7):973-982. doi: 10.1111/dme.13325. Epub 2017 Feb 28.
PubMed 28164367Faessler L, Kutz A, Haubitz S, Mueller B, Perrig-Chiello P, Schuetz P. Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study. BMC Emerg Med. 2016 Aug 24;16(1):33. doi: 10.1186/s12873-016-0097-y.
PubMed 27557531Laukemann S, Kasper N, Kulkarni P, Steiner D, Rast AC, Kutz A, Felder S, Haubitz S, Faessler L, Huber A, Fux CA, Mueller B, Schuetz P. Can We Reduce Negative Blood Cultures With Clinical Scores and Blood Markers? Results From an Observational Cohort Study. Medicine (Baltimore). 2015 Dec;94(49):e2264. doi: 10.1097/MD.0000000000002264.
PubMed 26656373Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L, Kutz A, Conca A, Reutlinger B, Canavaggio P, Sauvin G, Bernard M, Huber A, Mueller B; TRIAGE Study group. Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Crit Care. 2015 Oct 29;19:377. doi: 10.1186/s13054-015-1098-z.
PubMed 26511878Steiner D, Renetseder F, Kutz A, Haubitz S, Faessler L, Anderson JB, Laukemann S, Rast AC, Felder S, Conca A, Reutlinger B, Batschwaroff M, Tobias P, Buergi U, Mueller B, Schuetz P. Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study. J Emerg Med. 2016 Apr;50(4):678-89. doi: 10.1016/j.jemermed.2015.09.008. Epub 2015 Oct 14.
PubMed 26458788Schuetz P, Hausfater P, Amin D, Haubitz S, Fassler L, Grolimund E, Kutz A, Schild U, Caldara Z, Regez K, Zhydkov A, Kahles T, Nedeltchev K, von Felten S, De Geest S, Conca A, Schafer-Keller P, Huber A, Bargetzi M, Buergi U, Sauvin G, Perrig-Chiello P, Reutlinger B, Mueller B. Optimizing triage and hospitalization in adult general medical emergency patients: the triage project. BMC Emerg Med. 2013 Jul 4;13:12. doi: 10.1186/1471-227X-13-12.
PubMed 23822525
Study at a glance
From the registry record, last updated by the sponsor on 12 Dec 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimizing Triage and Hospitalisation In Adult General Medical Emergency Patients: the TRIAGE Study
- ClinicalTrials.gov ID
- NCT01768494
- Acronym / sponsor ID
- TRIAGE / TRIAGE-1
- Conditions
- Emergencies
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 7,000 participants (actual)
- Lead sponsor
- University Hospital, Basel, SwitzerlandUniversity, hospital or other
- Study start
- Mar 2013
- Primary completion
- Oct 2014 (actual)
- Study completion
- Oct 2014 (actual)
- First posted
- 15 Jan 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal initial triage. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site of care decision and to simplify early discharge management. Herein, we propose a large prospective cohort study to optimize initial patient triage for (a) better determination of initial treatment priority, (b) overall risk and need for inhospital treatment and (c) early assessment of post-acute nursing needs.
Detailed description
Background: Patients presenting to the emergency department (ED) currently face inacceptable delays in initial treatment, and long and costly hospital stays due to suboptimal initial triage. Accurate ED triage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs to improve site of care decision and to simplify early discharge management. Different triage scores have been proposed, such as the Manchester Triage Score (MTS). Yet, these scores focus only on treatment priority, have suboptimal performance and lack validation in the Swiss Health care system. Because the MTS will be introduced into clinical routine of the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial patient triage. Specifically, the aim of this trial is to derive a three part triage algorithm to better predict (a) treatment priority; (b) medical risk and thus need for inhospital treatment; (c) post-acute care needs of patient's at the most proximal time point of ED admission.
Methods / Design: Prospective, observational, cohort study. We will include all consecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for non-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later batch analysis of blood markers. Upon ED discharge, the post-acute care score will be recorded. Attending ED physicians will adjudicate triage priority based on all available results at the time of discharge. Patients will be reassessed daily during the hospital course for medical and nursing stability. To assess outcomes, data from electronic medical records will be used and all patient will be contacted 30 days after hospital admission to assess vital status, rehospitalisation and quality of life measures.
We aim to include between 5000 and 7000 patients over one year of recruitment to derive the three part triage algorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated by the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission to assess patients risk and thus need for inhospital treatment and (c) care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early recognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to initiation of adequate medical therapy, length of hospital stay, patient's satisfaction with care and overall hospital costs.
Discussion: Using a reliable initial triage system for estimating initial treatment priority, need for inhospital treatment and post-acute care needs is an innovative and persuasive approach for a more targeted management of medical patients in the ED. Our group has proven feasibility with a track record of several completed and ongoing trials. The proposed interdisciplinary project has unprecedented potential to improve initial triage decisions and optimize resource allocation to the sickest patients from admission to discharge. The algorithms derived in this study will be compared in a later randomized controlled trial against a usual care control group in terms of resource use, length of hospital stay, overall costs and patient's outcomes in terms of mortality, rehospitalisation, quality of life and satisfaction with care.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- All consecutive medical patients seeking ED care will be included. There will be no exclusions except for non-adult and non-medical patients. We expect to include 5000 - 8000 patients over one year of recruitment.
Key inclusion criteria (1 listed)
- All consecutive medical patients seeking ED care
Key exclusion criteria (1 listed)
- age below 18 years
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Initial triage priority
Time frame: within 30 days
Initial triage priority adjudicated by the attending ED physician. Attending ED physicians will classify all patients at ED discharge as either high triage priority or low triage priority in respect to the time patients need to be seen by a physician based on all available information at ED discharge
Adverse 30 day outcome (death or intensive care unit admission) within 30 days following ED admission
Time frame: Within 30 days of ED admission
Adverse 30 day outcome (death or intensive care unit admission) within the hospital stay and within 30 days following ED admission
Care needs after hospital discharge
Time frame: Within 30 days
Care needs after hospital discharge will be defined as transfer of patients to a post-acute care institution (i.e. transition to a nursing home and others).
4 secondary outcomes
Time to first physician contact
Time frame: Within 30 days
Time to initiation of adequate medical therapy
Time frame: Wihtin 30 days
Satisfaction with care
Time frame: Within 30 days
Hospital costs
Time frame: Within 30 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Dec 2014.
- Derived from this study: PubMed 33554514Haag E, Gregoriano C, Molitor A, Kloter M, Kutz A, Mueller B, Schuetz P. Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study. Clin Chem Lab Med. 2021 Jan 14;59(6):1165-1176. doi: 10.1515/cclm-2020-1566. Print 2021 May 26.
- Derived from this study: PubMed 30782737Eckart A, Hauser SI, Kutz A, Haubitz S, Hausfater P, Amin D, Amin A, Huber A, Mueller B, Schuetz P. Combination of the National Early Warning Score (NEWS) and inflammatory biomarkers for early risk stratification in emergency department patients: results of a multinational, observational study. BMJ Open. 2019 Jan 17;9(1):e024636. doi: 10.1136/bmjopen-2018-024636.
- Derived from this study: PubMed 30647051Eckart A, Hauser SI, Haubitz S, Struja T, Kutz A, Koch D, Neeser O, Meier MA, Mueller B, Schuetz P. Validation of the hospital frailty risk score in a tertiary care hospital in Switzerland: results of a prospective, observational study. BMJ Open. 2019 Jan 15;9(1):e026923. doi: 10.1136/bmjopen-2018-026923.
- Derived from this study: PubMed 28164367Kutz A, Struja T, Hausfater P, Amin D, Amin A, Haubitz S, Bernard M, Huber A, Mueller B, Schuetz P; TRIAGE study group. The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study. Diabet Med. 2017 Jul;34(7):973-982. doi: 10.1111/dme.13325. Epub 2017 Feb 28.
- Derived from this study: PubMed 27557531Faessler L, Kutz A, Haubitz S, Mueller B, Perrig-Chiello P, Schuetz P. Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study. BMC Emerg Med. 2016 Aug 24;16(1):33. doi: 10.1186/s12873-016-0097-y.
- Derived from this study: PubMed 26656373Laukemann S, Kasper N, Kulkarni P, Steiner D, Rast AC, Kutz A, Felder S, Haubitz S, Faessler L, Huber A, Fux CA, Mueller B, Schuetz P. Can We Reduce Negative Blood Cultures With Clinical Scores and Blood Markers? Results From an Observational Cohort Study. Medicine (Baltimore). 2015 Dec;94(49):e2264. doi: 10.1097/MD.0000000000002264.
- Derived from this study: PubMed 26511878Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L, Kutz A, Conca A, Reutlinger B, Canavaggio P, Sauvin G, Bernard M, Huber A, Mueller B; TRIAGE Study group. Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Crit Care. 2015 Oct 29;19:377. doi: 10.1186/s13054-015-1098-z.
- Derived from this study: PubMed 26458788Steiner D, Renetseder F, Kutz A, Haubitz S, Faessler L, Anderson JB, Laukemann S, Rast AC, Felder S, Conca A, Reutlinger B, Batschwaroff M, Tobias P, Buergi U, Mueller B, Schuetz P. Performance of the Manchester Triage System in Adult Medical Emergency Patients: A Prospective Cohort Study. J Emerg Med. 2016 Apr;50(4):678-89. doi: 10.1016/j.jemermed.2015.09.008. Epub 2015 Oct 14.
- Derived from this study: PubMed 23822525Schuetz P, Hausfater P, Amin D, Haubitz S, Fassler L, Grolimund E, Kutz A, Schild U, Caldara Z, Regez K, Zhydkov A, Kahles T, Nedeltchev K, von Felten S, De Geest S, Conca A, Schafer-Keller P, Huber A, Bargetzi M, Buergi U, Sauvin G, Perrig-Chiello P, Reutlinger B, Mueller B. Optimizing triage and hospitalization in adult general medical emergency patients: the triage project. BMC Emerg Med. 2013 Jul 4;13:12. doi: 10.1186/1471-227X-13-12.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Philipp Schütz, PD Dr. med. principal investigator
Medical University Clinic, Kantonsspital Aarau, Switzerland
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Emergencies, run by University Hospital, Basel, Switzerland at 1 site in Switzerland.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Dec 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Initial triage priority (time frame: within 30 days). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT01768494, which also lists 9 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Dec 2014.