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Seed Grant Profile


2006-2007 Program

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Comprehensive Analysis of Patient Triage in Urban Pediatric Emergency Departments

The Emergency Severity Index (ESI) system is a patient triage model recently adopted at Children's Healthcare of Atlanta (CHOA) for implementation in two urban pediatric emergency departments (ED) starting in August 2006. The decision to use ESI is primarily due to the current four-tier model's poor reproducibility, poor correlation to resource utilization, and tendency to misclassify both critical and non-critical patients.

To be able to provide quality and timely care to pediatric ED patients, it is critical to investigate effective patient triage methods as well as improve resource utilization. This urgency is compounded by the planned CHOA ED expansion in each of its two campuses, Scottish Rite and Egleston. This project brings together researchers at Georgia Institute of Technology and CHOA to investigate the efficacy of Emergency Severity Index (ESI) triage in determining resource utilization, and short- and long-term staffing needs while maintaining a high quality of care.

Primary aims of this project include: 1) compare immediate performance outcomes of the conventional four-tier triage versus the ESI system; 2) evaluate long-term ESI performance outcomes; 3) analyze how proper triage categorization affects staffing projections and resource utilization/optimization; and 4) develop an operational planning tool to forecast optimal staffing, appropriate resource utilization, and future ED expansion needs.

The broad impact of this proposed research includes: 1) improvement of correct triage categorization of patients upon admission into the emergency care service; 2) decrease in the number of patients who leave without being seen by a physician due to incorrect "fast-track" categorization and inefficient resource utilization; 3) improvement in timeliness of care, in directing proper care, and thus in overall quality-of-care for pediatric ED patients; 4) improvement of hospital resource utilization and cost-effectiveness of staff and resources assigned to patient care; 5) improvement of operations efficiency related to billing. The results obtained in this seed grant, including the establishment of working relationships with various teams of ED personnel within the two CHOA hospital campuses, will be key to the success of applications for external funding to the Agency of Healthcare Research and Quality, Health Resources and Services Administration, National Library of Medicine, National Science Foundation, and Robert Wood Johnson Foundation.

Investigators: Eva K. Lee (GT, Industrial & Systems Engineering) and Michael A. DeGuzman (Children's Healthcare of Atlanta, Emergency Services)

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