A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (MMed) in the Division of Emergency Medicine. Johannesburg, 2014 / Introduction: Over-triage and access-block are worldwide phenomena which critically compromise patient care and increase morbidity and mortality. Triage is designed to place the patient in the right place at the right time with the right resources. We sought to determine and evaluate the application reliability of the South African Triage Score/Scale (SATS) in adult emergency cases presenting to a central academic hospital and to identify which factors may have influenced this. Methods: Emergency department (ED) triage data for adult patients at a central academic hospital in Johannesburg over a seven day period were captured retrospectively. The investigator applied the SATS 2008 to each triage form. Triage scores and colour banding for the trieur versus the investigator were compared and the overall degree of triage concordance and discordance observed. Results: A total sample size of 1758 cases was recorded. Moderate agreement (quadratically weighted  0.524 at 95%CI 0.450-0.598) for the overall triage banding assignment revealed rates of concordance of 50.6%, discordance of 49.4%, over-triage of 28.5% and under-triage of 20.9%. Tuesday showed the highest patient load with 21.3% of the weekly total. The mean daily and hourly patient loads were 285 and 14 respectively. Time of day analysis showed a daytime predominance of 2/3 of total presentations and a peak hour between 08h00-09h00. Conclusions: The over-triage (28.5%) rate fell within the American College of Surgeons Committee on Trauma’s (ACSCOT) accepted rate of 30-50%, while under-triage (20.9%) exceeded the accepted ACSCOT levels (<10%). When the triage score was calculated and recorded there was improved concordance, interrater reliability and reduced over-triage. The discordance levels of over-triage decreased and under-triage increased respectively with increasing patient acuity. There was no significant correlation between the extent of triage concordance or discordance and patient load.

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (M.S.)--University of Michigan, 1976.

published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M. Med. Sc.)--University of Hong Kong, 2005. / Also available in print.

Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, September 2009. / Thesis Advisor(s): Richter, Anke ; Bergin, Richard. "September 2009." Description based on title screen as viewed on November 5, 2009. Author(s) subject terms: Patient Tracking, Public Health, Emergency Medical Services, Patient Movement, Evacuation, Public Health Preparedness. Includes bibliographical references (p. 139-140). Also available in print.

Thesis--Columbia University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-165).

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2000. / Includes bibliographical references.

Thesis (M. Nurs.)--University of Hong Kong, 2004. / Also available in print.