ED triage of patients with acute myocardial infarction: predictors of low acuity triage

Objective: Virtually all emergency department (ED) patients receive an ED triage assessment that determines their priority to be seen by a physician. Previous research found that half of patients who are having an acute myocardial infarction (AMI) are given a low priority triage score, which is associated with delays in electrocardiogram (ECG) acquisition and reperfusion therapy. We sought to determine some of the reasons why ED triage is failing in these patients. Methods: We conducted a retrospective cohort analysis of a population-based cohort of AMI patients admitted to 102 acute care hospitals in Ontario, Canada, from July 2000 to March 2001. We examined 10 potential patient- and hospital-level predictors of low acuity triage: age, sex, number of comorbidities, arrival mode, socioeconomic status, time of day, day of week, ED AMI volume, hospital type, and department use of triage ECGs. Results: Mean age of the 3088 patients was 67.5 (SD, 14.0), and 65% were men. In adjusted quantile regression analyses, low acuity triage was independently associated with ED AMI volume (odds ratio [On 0.44 at very high volume centers), arrival mode (OR, 0.60 for ambulance arrival), sex (OR, 0.80 for males), age (OR, 1.1 per 10 years of age), and a low number of comorbidities (OR, 0.92 for every cardiac co-morbidity). Conclusions: Low acuity ED triage of AMI patients may be predicted by several patient- and hospital-level characteristics. Focusing future interventions on these factors may improve ED triage and, subsequently, time to initial ECG and reperfusion, in this patient group. (C) 2010 Elsevier Inc. All rights reserved.