Comparison of Canadian triage acuity scale to Australian Emergency Mental Health Scale triage system for psychiatric patients

• A traditional triage system should define patient care needs based on the acuity of their conditions.
• These triage systems were developed based on physical illness and injury and not based on patients who presented with mental health concerns.
• The Canadian Triage Acuity System (CTAS) and Australian Emergency Mental Health (AEMH) triage systems, when compared, result in different outcomes.
• The (AEMH) system rated the patients as far less urgent, compared to the CTAS, and was better able to meet the recommendations for times for medical evaluation.
• By educating triage staff and providing less ambiguous more mental health specific triage guidelines, there were changes in the way the staff classifies patients.
• Use of the AEMH can allow for improvement in patient outcomes by better matching the ED's resources to the psychiatric patients' specific needs. These differences indicate the impact of using specialized triage systems to address the needs of psychiatric patients who present to the ED.

ObjectivesThe purpose of the study was to compare the Canadian Triage and Acuity Scale protocol to the Australian Emergency Mental Health Triage System protocol for evaluation of psychiatric patients and time to be evaluated in the emergency department.MethodsA convenience sample of 105 patients who presented with psychiatric complaints at triage was given the Canadian Triage and Acuity Scale (CTAS) by the nurse at triage. A second triage assessment using the Australian Emergency Mental Health Triage Scale was performed by trained research fellows. The study was performed at an inner city level one trauma center with 40,000 visits per year during 2012. The study was approved by the IRB.ResultsUse of the CTAS rated almost half the patients (48%) urgent and (29%) emergent. The Australian Emergency Mental Health Triage Scale scored the same patients differently with (75%) coding as no danger to self or others, (18%) scoring as in moderate distress. The CTAS was not able to meet the recommended times to be seen, especially for patients rated as urgent. The Australian Emergency Mental Health Scale system, with the exception of triage level 1, was able to meet the recommendations for wait times to be medically evaluated and in the case of the lower levels seen sooner than recommended.ConclusionsThe use of the CTAS protocol does not correlate with patients' being medically evaluated within the time frames recommended especially for the more urgent patients. The Australian Emergency Mental Health Scale rated patients' presentations as far less urgent and thus the time frame recommendations to be evaluated were more closely aligned with the protocol as compared to the CTAS system. The Australian Emergency Mental Health Scale provided less ambiguous mental health specific triage guidelines that allowed for improvements in patient outcomes by better matching the ED's resources to the psychiatric patients' specific needs.