Patient Safety / Innovative care models for vulnerable Emergency Department patient groups

Patient Safety:

RemEDy (Reducing Mistriage in Emergency Departments)

The demand for emergency care varies and can change rapidly. Emergency Department (ED) performance depends on the number of patients who present, and their flow through the ED to their safest and most appropriate disposition (admission to tertiary care, referral to one of the partnering hospitals, or discharge). Effective triage is critical for the safe management of patients presenting to the ED, ensuring the right patient receives the right care at the right time in the right place with the right resources. Despite the recognized importance of accurate triage of emergency department patients, approximately 20% to 30% experience incorrect triage level assignment, known as mistriage. Mistriage might be associated with adverse health outcomes. To enhance triage accuracy, it is crucial to understand the causes of mistriage and how they are associated with the characteristics of patients, triage clinicians, and ED metrics. A comprehensive understanding of mistriage will allow for the identification of potential areas for improvement, leading to the development of measures to avoid it. RemEDy (Reducing Mistriage in Emergency Departments) will identify and analyze mistriage in a real-time triage setting in 7 ED’s in German-speaking Switzerland, comparing routine triage procedures with expert triage simultaneously, and develop and evaluate an AI model that can potentially assist with triage decisions, aiming to detect patients who should not wait early. Based on the results, we will develop a learning module for triage clinicians and assess its effectiveness in reducing mistriage. This could result in enhanced accuracy in triage code assignment, thereby reducing mistriage and its associated consequences.

Innovative care models for vulnerable ED patient groups:

DIME (Delphi - informed medcial evaluation)

Patients with mental health symptoms are often referred to the ED for medical evaluation to exclude medical causes before admission to psychiatry. The absence of a prospectively validated medical screening tool leads to wide practice variation. This study assembles stakeholders from national and international societies in emergency medicine and psychiatry on 4 continents in a modified Delphi process with the aim of collaboratively developing an evidence-based, quick, safe, and easy-to-use practical screening tool, which will be validated in a prospective, international, multi-center observational study.

Contextual analysis and implementation strategies for a senior-FRiendly Emergency Department (FRED): A third of patients presenting to the ED at the University Hospital in Basel are aged 65 and older, a third of those are frail. Over the last 13 years our interdisciplinary team introduced senior-friendly interventions and achieved Geriatric Emergency Department Accreditation in 2024 to further enhance care processes and compare outcomes. However, the impact of previously introduced interventions—and the reasons behind emergency clinicians’ varying uptake—remain unclear. FRED aims to systematically promote the uptake and sustainable re-implementation of the existing comprehensive senior-friendly ED program to increase patient reach and sustainability of our senior-friendly interventions.

Selected Publications

Kabell Nissen S, Rueegg M, Carpenter CR, Kaeppeli T, Busch JM, Fournaise A, Dreher-Hummel T, Bingisser R, Brabrand M, & Nickel CH. (2023). Prognosis for older people at presentation to emergency department based on frailty and aggregated vital signs. Journal of the American Geriatrics Society, 71(4), 1250–1258. https://doi.org/10.1111/jgs.18170

URLs

Kaeppeli T, Rueegg M, Dreher-Hummel T, Brabrand M, Kabell-Nissen S, Carpenter CR, Bingisser R, & Nickel CH. (2020). Validation of the Clinical Frailty Scale for Prediction of Thirty-Day Mortality in the Emergency Department. Annals of Emergency Medicine, 76(3), 291–300. https://doi.org/10.1016/j.annemergmed.2020.03.028

URLs

Selected Projects & Collaborations

REMEDY (Reducing Mistriage in Emergency Departments: A Path to Improved Triage Accuracy through Real-time Evaluation and Artificial Intelligence)

Research Project | 4 Project Members

Imported from Grants Tool 4707568

RemEDy (Reducing Mistriage in Emergency Departments)
The demand for emergency care varies and can change rapidly. Emergency Department (ED) performance depends on the number of patients who present, and their flow through the ED to their safest and most appropriate disposition (admission to tertiary care, referral to one of the partnering hospitals, or discharge). Effective triage is critical for the safe management of patients presenting to the ED, ensuring the right patient receives the right care at the right time in the right place with the right resources. Despite the recognized importance of accurate triage of emergency department patients, approximately 20% to 30% experience incorrect triage level assignment, known as mistriage. Mistriage might be associated with adverse health outcomes. To enhance triage accuracy, it is crucial to understand the causes of mistriage and how they are associated with the characteristics of patients, triage clinicians, and ED metrics. A comprehensive understanding of mistriage will allow for the identification of potential areas for improvement, leading to the development of measures to avoid it. RemEDy (Reducing Mistriage in Emergency Departments) will identify and analyze mistriage in a real-time triage setting in 7 ED’s in German-speaking Switzerland, comparing routine triage procedures with expert triage simultaneously, and develop and evaluate an AI model that can potentially assist with triage decisions, aiming to detect patients who should not wait early. Based on the results, we will develop a learning module for triage clinicians and assess its effectiveness in reducing mistriage. This could result in enhanced accuracy in triage code assignment, thereby reducing mistriage and its associated consequences.

Defining the need for analgesia in the emergency department: protocol for an international Delphi Process

Research Project | 12 Project Members

Introduction
The high prevalence of pain in the emergency department (ED) highlights the importance of an accurate assessments to provide effective interventions. However, common pain scales such as the numerical pain rating scale have shown limitations in assessing analgesic requirements and adequacy. The ideal outcome for evaluating a pain scale predicting analgesic requirements would be the “need for analgesia”, for which there is no universally accepted definition. Accordingly, the primary aim of this study is to define the “need for analgesia” using an interdisciplinary approach. The secondary aim is to define the “adequacy of analgesia”.

Methods and analysis
A two-stage modified Delphi process will be conducted by a core study group chosen for its expertise in ED pain management. A larger expert panel, identified through a comprehensive search in Scopus and CINAHL databases, will be invited to participate in the study and will be supplemented by patients recruited via International Patient Organizations. In Stage 1, the expert panel will complete a written survey to collect potential clinical variables for defining the “need for analgesia” and “adequacy of analgesia”. The core study group will elaborate these variables. In stage 2, the same participants will use a five-point Likert scale to achieve consensus defined as 80% of combined agreement on the proposed variables. The same process will be used to define the “adequacy of analgesia”.

Ethics and Dissemination
The Ethics Committee of Northwestern and Central Switzerland exempted the project from committee approval under the Human Research Act. Written consent will be obtained from all participants. Results will be disseminated through publication in peer-reviewed journals and conferences.

Prof. Dr. med. Christian Nickel