treatment, and long, costly hospital stays due to suboptimal initial triage and site-of-care decisions. Accurate ED\r\ntriage should focus not only on initial treatment priority, but also on prediction of medical risk and nursing needs\r\nto improve site-of-care decisions and to simplify early discharge management. Different triage scores have been\r\nproposed, such as the Manchester triage system (MTS). Yet, these scores focus only on treatment priority, have\r\nsuboptimal performance and lack validation in the Swiss health care system. Because the MTS will be introduced\r\ninto clinical routine at the Kantonsspital Aarau, we propose a large prospective cohort study to optimize initial\r\npatient triage. Specifically, the aim of this trial is to derive a three-part triage algorithm to better predict (a)\r\ntreatment priority; (b) medical risk and thus need for in-hospital treatment; (c) post-acute care needs of patients at\r\nthe most proximal time point of ED admission.\r\nMethods/design: Prospective, observational, multicenter, multi-national cohort study. We will include all\r\nconsecutive medical patients seeking ED care into this observational registry. There will be no exclusions except for\r\nnon-adult and non-medical patients. Vital signs will be recorded and left over blood samples will be stored for later\r\nbatch analysis of blood markers. Upon ED admission, the post-acute care discharge score (PACD) will be recorded.\r\nAttending ED physicians will adjudicate triage priority based on all available results at the time of ED discharge to\r\nthe medical ward. Patients will be reassessed daily during the hospital course for medical stability and readiness for\r\ndischarge from the nurses and if involved social workers perspective. To assess outcomes, data from electronic\r\nmedical records will be used and all patients will be contacted 30 days after hospital admission to assess vital and\r\nfunctional status, re-hospitalization, satisfaction with care and quality of life measures.\r\nWe aim to include between 5000 and 7000 patients over one year of recruitment to derive the three-part triage\r\nalgorithm. The respective main endpoints were defined as (a) initial triage priority (high vs. low priority) adjudicated\r\nby the attending ED physician at ED discharge, (b) adverse 30 day outcome (death or intensive care unit admission)\r\nwithin 30 days following ED admission to assess patients risk and thus need for in-hospital treatment and (c) post\r\nacute care needs after hospital discharge, defined as transfer of patients to a post-acute care institution, for early\r\nrecognition and planning of post-acute care needs. Other outcomes are time to first physician contact, time to
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