Identification of the Sick Patient in the ED
Identification of the Sick Patient in the ED
This non-interventional study will test scoring systems used to identify high risk patients
 when they are triaged upon presentation in the Emergency Department (ED) in a single hospital
 in the Northwest of England between May and July 2017.E The study will involve collecting
 data only from a cohort of 500 consecutive patients who arrive at the ED. Patients who have a
 traumatic, purely obstetric or purely psychiatric condition will be excluded.

 Patients will be triaged as is routine by nursing and medical staff using various scoring
 methods determine whether they are high risk and need urgent, life-saving treatment. In
 addition the impression (yes/no) of the triaging nurse and the treating clinician as to
 whether the patient will need a life-saving intervention will be collected. Patients will be
 followed up for 48 hours to see whether they needed any life-saving treatment, such as
 admission to ICU, life-saving surgery, cardiopulmonary resuscitation (CPR), or death.

 Each patient's Manchester Triage category, NEWS at presentation, nurse and treating clinician
 impressions and a novel score calculated from NEWS data will be collected together with the
 outcome data in order to compare the predictive power of the five scoring systems. In this
 way the study will test which is the best scoring system for identifying high risk patients
 in a timely manner. This is important as it can allow life saving treatment to be delivered
 quickly to those patients who need it most and can prevent inappropriate interventions on
 patients who do not immediately need them. The study will collect minimal patient information
 and will not interfere with or alter their treatment in any way. Only patient data recorded
 as part of routine practice is required, which will be collected by members of the direct
 care team and will be anonymised prior to analysis.
This is a single-centre, non-interventional, prospective observational cohort study
 collecting data from patients presenting to the ED of a large teaching hospital in the
 Northwest of England. The study is designed to gather information about the number of
 patients receiving life-saving intervention within 48 hours of presentation and the best of
 five proposed ways of identifying these patients when they present to the ED. This study is
 non-interventional and there will be no interference with treatment decisions or alteration
 in clinical practice.

 A prospective observational approach is chosen as it will allow direct access to information
 and better capture of the systems being assessed in the ED. Information about each patient's
 perceived risk at presentation (in terms of the five proposed systems) will be collected at
 the time of presentation. Information will include rating on the five proposed systems and a
 number of outcome variables, all of which are recorded as part of routine clinical practice.
 All information will be captured directly into a specially designed database including a
 study number to preclude the need to record any personal identifiable information for the
 study.

 Data will be collected for each patient on an anonymised database. Demographic details (age,
 gender, presenting condition) will be collected to identify if the sample is representative
 of a general ED population. Each patient's Manchester Triage category, NEWS at presentation
 and the novel score calculated from NEWS data will be included, as will the impression
 (yes/no) of the triaging nurse and the treating clinician as to whether the patient will need
 a lifesaving intervention. A number of outcome measures (death, admission to high dependency
 or intensive care, admission directly to the cardiac catheter laboratory or coronary care,
 emergency endoscopy, thrombolysis, life-saving surgery, intubation, emergency intravenous
 medication, CPR, DC cardioversion/external or internal cardiac pacing, massive transfusion
 for ongoing haemorrhage and non-invasive ventilatory support) will be extracted, having been
 defined a priori as being potentially life-saving. The demographic details and variables
 chosen are all recorded or calculated for each patient as part of routine practice on
 critical care. No additional tests or measurements will be required for this study.

 Data will be anonymised by allocation of a study number and this figure will be
 cross-referenced to an electronic masterlist which will contain the patient name and hospital
 number. In this way the database can be linked back to the patient to continue data
 collection and entry. The masterlist will be an electronic spreadsheet which will be stored
 on a secure server at the hospital and accessed via password protected computers within the
 ED. The masterlist will be destroyed on completion of the study.

 Patient information will be collected in a spreadsheet designed to collate the information
 and allow statistical analysis. No identifiable patient information will be inputted onto the
 spreadsheet
Inclusion Criteria:

 -  Presenting to Royal Preston Hospital Emergency Department

 Exclusion Criteria:

 -  Trauma, purely psychiatric or obstetric presentation