Reverse triage: more than just another method

Abstract

Reverse triage is a way to rapidly create inpatient surge capacity by identifying hospitalized patients who do not require major medical assistance for at least 96 h and who only have a small risk for serious complications resulting from early discharge. Electronic searches were conducted in the MEDLINE, TRIP, Cochrane Library, CINAHL, EMBASE, Web of Science, and SCOPUS databases to identify relevant publications published from 2004 to 2014. The reference lists of all relevant articles were screened for additional relevant studies that might have been missed in the primary searches. There will always be small individual differences in the reverse triage decision process, influencing the potential effect on surge capacity, but at most, 10-20% of hospital total bed capacity can be made available within a few hours. Reverse triage could be a response to Emergency Department (ED) crowding, as it gives priority to ED patients with urgent needs over inpatients who can be discharged with little to no health risks. The early discharge of inpatients entails negative consequences. They often return to the ED for further assessment, treatment, and even readmission. When time to a medical referral or bed is less than 4-6 h, 100 additional lives per annum are predicted to be potentially saved. The results of our systematic review identified only a small number of publications addressing reverse triage, indicating that reverse triage and surge capacity are relatively new subjects of research within the medical field. Not all research questions could be fully answered.

Triage Systems in Mass Casualty Incidents and Disasters: A Review Study with A Worldwide Approach

“…Reverse triage is also a way to increase the capacity of the emergency unit of the hospital during disasters. Accordingly, those patients with mild injuries and those supposed to be without any medical complications for at least 96 hours after discharge are at the top of the discharge list [8].…”

Telemedicine-enabled Accelerated Discharge of Patients Hospitalized with COVID-19 to Isolation in Repurposed Hotel Rooms

“…Our viewpoint is that expansion of high-dependency unit and ICU capacity is best achieved by upgrading existing lower-dependency beds rather than by building de novo field hospitals from scratch without the integrated complex infrastructure required for hospital-based care, including oxygen. This approach identifies a sort of “reverse triage,” which has already been used in other types of catastrophic events to increase the capacity of ICUs and emergency departments ( 2 ), and could solve several problems, including diversion of mechanical ventilators and highly trained staff away from existing hospitals that are trying to expand their capacities to meet the surge in demand.…”

Coronavirus-19 pandemic: A two-step triage protocol for emergency department

“…A separate triage category for patients coming in extremis should be made, labeled blue or gray, where decision to resuscitate is made on case to case basis. As the case load increases, the hospital may eventually resort to “reverse triage.”[ 6 ]…”