Key result
Reverse triage yields a low 22% sensitivity for predicting safe discharge despite high specificity.
Why the study?
Reverse triage has been proposed to manage hospital surges but its safety and effectiveness alone or combined with readmission screening tools for appropriate discharge were uncertain.
Does reverse triage and readmission screening tools safely and effectively predict appropriate discharge in medical inpatients?
Observational
No
Does reverse triage and readmission screening tools safely and effectively predict appropriate discharge in medical inpatients?
p-value: p=0.0002
Reverse triage, especially when combined with the HOSPITAL score, is a highly specific and safe tool for identifying medical inpatients eligible for early discharge.
High specificity may aid safe discharge identification in observational data; leaves open prospective validation of combined tools before practice change.
BACKGROUND: Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. MATERIAL AND METHODS: ) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. RESULTS: [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. CONCLUSIONS: Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.
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Caramello et al. (2018) conducted an observational in Inpatients of medical divisions. Reverse triage (RT) score ≤3 alone and with readmission screening tools was evaluated on Consequential medical events following hypothetical discharge (reinstituting interventions, transfer to increased care, death, and readmission) (p=0.0002). Reverse triage demonstrated low sensitivity (22%) and high specificity (95%) for predicting safe discharge, with the HOSPITAL score showing 84% concordance with RT.
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