Call for change

When Ontario’s triage nurses face an ER case, they need to observe and evaluate patients effectively and communicate clearly while correctly applying the Canadian Triage Acuity Scale (CTAS) to ensure patients have the best possible experience. But getting an accurate CTAS score means weighing thousands of combinations of 169 presenting complaints and more than 400 modifiers that refine the severity of the patient’s vital signs and symptoms. ERs in Ontario log more than five million patients each year, according to a provincial review which documented that 44 percent of ER patients are being triaged inappropriately. Hospitals and individual practitioners followed varying methods for patient intake, diagnosis and documentation, and many processes were manual. To address the challenge, the Ministry of Health granted funds for the development of an electronic decision-support tool.

When tech meets human ingenuity

Ontario Health sought assistance from Accenture in developing the Electronic Canadian Triage and Acuity Scale (eCTAS) solution to ensure that patients feel safe and benefit from improved access to ER care, more human treatment experiences and better health outcomes. The project began with input from nurse practitioners and other emergency room staff across Ontario. Accenture worked with Avanade and Ontario Health to develop the algorithm, put it in a production environment, test it and make modifications. The automated tool enables ER nurses to triage patients by type and severity of symptoms, ensuring the best possible outcomes for serious cases. This ensures that the worst cases access care first, and the relative need for care is constantly reassessed, ensuring the best possible health outcomes for Ontarians.

A valuable difference

The system has given nurses a trusted tool at the point of care. Citizens are likely to encounter more accurate triage and better access to critical care. eCTAS is now in use across Ontario and has demonstrably improved triage effectiveness and ensured shorter waiting times for more critical patients. Within a year, the tool was being used to triage about 400,000 patients monthly. Pre- and post-launch audits indicate the tool achieved a 17 percent increase in triage appropriateness. By the following year, over 100 hospitals in Ontario were using eCTAS to triage 85 percent of all Ontarian ER patients. Provinces and hospitals around the world continue to seek effective, data-driven ER support, and eCTAS sets a standard for them to follow.

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