Facilitating the Reverse Triage Selection process in times of disaster and crowding

Mass casualty incidents (MCIs) such as terrorist attacks (e.g. Brussels, March 22, 2016) or the present CoViD-19 pandemic, can no longer be ignored in today’s society. They lead to unexpected and sudden increases in patient volume at hospitals. This major influx can easily overwhelm an emergency department (ED) and even the entire hospital’s capacity and resources. A healthcare system’s ability to rapidly expand its normal capacity to meet the increase in demand is called surge capacity. If full surge capacity is not achieved quickly, ED crowding will occur, leading to a decrease in the overall quality of delivered patient care. For most situations, it is assumed that hospitals should be able to sustain medical services for up to 96h without external aid. To ensure this, methods to improve surge capacity are being developed. One of these methods – called reverse triage – addresses both problems by simultaneously creating additional surge capacity and reducing crowding. Reverse triage suggests that patients who need the least amount of medical assistance need to be prioritized so that they can be discharged as soon as possible. Reverse triage a way to rapidly create inpatient surge capacity by identifying hospitalized patients who do not require major medical assistance for at least 96h and who only have a small risk for serious complications resulting from early discharge. Such patients can potentially be discharged early in MCIs so that disaster victims, who are in greater need of hospital care and resources, can receive priority. Low-risk patients can be discharged home or to less acute-care facilities (e.g. nursing homes, public health contingency stations or an onsite nursing facility). Furthermore, the reverse triage principle could also be used to reduce daily ED crowding. By prioritizing ED patients who need urgent medical attention at the expense of inpatients, everyday hospital surge capacity can be achieved. Considering that in an MCI a certain range of risks is deemed acceptable that would otherwise be intolerable, cut-off values for receiving medical attention need to be reconsidered. They are probably lower than those tolerated during a disaster. This PhD is a continuation of an existing research line within our research unit. In our previous monocentric study, an evidence-based IT application was created. It uses the health electronic record (HER) of inpatients to speed up and guide the clinical decision-making in the reverse triage selection process. This application is called the Reverse Triage Tool Leuven (RTTL) and is capable of detecting hospitalized patients who unequivocally cannot be discharged early in a MCI. Doing so, the number of inpatients who need to be clinically evaluated for potential early discharge in MCI situations was reduced with 65%. We will now test the RTTL in various patient-case mixes and further refine it in order to reduce daily crowding in our emergency departments.