Doctors developing tool for nurses to better triage flu-symptom patients in ER

“When I work in the emergency room and I see a patient who has just spent 12 to 13 hours in the waiting room and I end up saying, ‘Go home, drink some water and take some Tylenol,’ it's disapointing and frustrating. For him and for me.”As a specialist and researcher in emergency medicine at Centre Hospitalier de Québec-Université Laval in Quebec City, Dr. Simon Berthelot is convinced it's possible to eliminate this unnecessary wait by providing nurses assigned to triage with a reliable predictive tool. The tool would allow them to “identify and stratify patients at risk of complications from those in whom the respiratory infection is benign and who do not need to see a doctor.”It's obvious how such a tool would reduce pressure respiratory viruses are lately putting on emergency departments, as was the case during the last holiday season when the trio of Influenza, COVID-19 and RSV caused record traffic peaks. “Patients without risk would not clutter up the waiting rooms, while patients at risk would be seen more quickly by a doctor,” said Dr. Berthelot.These ambulatory patients without risk of complications constitute a “clinical and economic burden for the health system,” and for themselves too. “This 12- to 13-hour wait is enormous, and it is unacceptable for the patient.” Time being money, “these unnecessary waiting times are very costly socially speaking,” he said, adding that the idea is not, “to push [these patients] away for the sake of pushing them back,” but to “find them the best place,” knowing that this is not an emergency for 30% to 60% of them, according to his estimates.It’s not your imagination: Hospital patients getting more complex according to study in B.C.Predictive tools already exist. As part of a systematic review of studies investigating their effectiveness, published in scientific journal Heliyon, Dr. Berthelot's research team identified 14 of note. Three of them had potential—the pneumonia severity score (CURB 65), the Pandemic Medical Early Warning Score (PMEWS) and the quick Sepsis-related Organ Failure Assessment (qSOFA) score—but have shortcomings that prevent their use in triage. “They do not make it possible to discriminate true positives from false positives, they lack selection criteria and, above all, they were developed to identify people at risk of complications and not those who are not.”Given these shortcomings, Dr. Berthelot and colleagues from three other hospital centres decided to develop their own predictive tool, the first version of which should be operational by the end of March. To do this, they carried out a study involving 1,200 patients who presented to the emergency room between February 2022 and March 2023 with symptoms of respiratory infection. Their evolution being known, the researchers were able to identify which characteristics to use to determine rules for discriminating the risk of complications.Read: Virtual ERs are still the topic of debate, but this one saved a lifeInitially, the researchers considered different options. The patients in their cohort responded to a self-assessment questionnaire upon arrival at the emergency department. “We quickly realized that they were not capable of objectively assessing their condition, because they lack discernment. If a person presents to the emergency room, it is because they are already convinced that they are at risk,” observed Dr. Berthelot. The researchers also gave them a PCR test, but it did not turn out to be that relevant in terms of prediction. “The test helps confirm that people have a viral infection, but it can heal on its own, while others are very sick.”Finally, the team moved towards a tool that combines a tree-based questionnaire for triage nurses and an improved PMEWS score. “We are in the process of refining it by adding variables such as vaccination status, comorbidities, medication taken, socio-economic background and home support.” Once finalized, the tool will be tested in the field as part of a Canadian multi-centre study. For it to be adopted, “We want it to be both reliable and easy to use, because triage nurses already have a very high workload,” said Dr. Berthelot.

Doctors developing tool for nurses to better triage flu-symptom patients in ER

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