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.