Short summary

The aim of this study is to investigate differences in the management of high acuity medical emergency patients (MEPs) in emergency departments (EDs) in Denmark (DK). This study examines trigger team activation criteria, along with training and composition of the trigger teams in the 21 hospitals in DK receiving MEPs (1).

Rationale

Management of critically ill patients in EDs remains a complex task. In DK 4 highly specialized hospitals and 17 minor hospitals have EDs receiving MEPs (1).

Each year several thousand patients are admitted to the Danish EDs with high acuity time critical medical conditions (2, 3). The initial treatment of MEPs is of major importance and requires highly skilled personnel as delays in treatment is often associated with increased mortality (4, 5).

For patients with time critical diagnoses such as stroke, STEMI and trauma, standardized procedures for managing these patients have been implemented in the EDs in major hospitals in DK. The outcome of these patient groups has significantly improved over the last decade due to optimization of management and care (6-9).

However, a large group of acute patients, MEPs, do not fit into the above categories. Standardized procedures for management upon arrival to the EDs lacks for MEPs - even though previous studies have found that MEPs account for most of ED trigger team activations (2, 3, 10). Whether optimization in management of MEPs can improve the outcome of this patient group has to be investigated.

MEPs are a heterogeneous group presenting with a wide range of ICD-10 diagnoses. Some of the most prevalent medical problems engaging the trigger teams are obstructed airways, respiratory insufficiency, shock, and unconsciousness (10, 11).

This diversity makes standardization of management of this patient group challenging. Previous studies have also found that MEPs have much higher mortality rates than other groups of emergency patients i.e., stroke, STEMI and trauma patients (10, 11).

Evidence supports that multidisciplinary trigger teams benefit the prognosis of MEPs (12). However, to the best of our knowledge, no guidelines on how to compose the most effective trigger team have been put forth neither nationally nor internationally (11). Furthermore, consensus is lacking on trigger team activation criteria.

A systematic approach to MEP management might help to improve the quality of care and outcome of this patient group.

The aim of this study is to describe the management of MEPs in EDs in DK. This study examines trigger team activation criteria, along with training and composition of the trigger teams in the 21 hospitals in DK receiving MEPs (1).

Description of the cohort

This study will be constructed as a cross sectional observational study of the 21 hospitals with EDs receiving MEPs in DK.

The procedure as to how this study will be conducted is inspired by Weile et al. (13). The questionnaire used is based on Weile et al.'s questionnaire but altered and adjusted to match the aim of this study.

Identification of hospitals with EDs receiving MEPs in DK is done by viewing the complete list of emergency hospitals in DK published by The Danish Ministry of Health (1). No private hospitals receive MEPs in DK.

An email will be sent to the head of each ED department with information about the study. They will be asked to recruit the eligible personnel mentioned below to answer the questionnaires.

A focused questionnaire regarding trigger team activation criteria, training and composition of trigger teams (appendix 1 and 2) will be send via OPEN to the following in each ED:

- The person responsible for activating the trigger call

- The head of department

- A trigger team senior physician

- A trigger team nurse

as they are expected to have profound knowledge and experience regarding medical trigger team composition, training and trigger team activation criteria.

If the questionnaire is not returned within 21 days, the head of department will be reminded via email to elicit a response. If the responders from each department do not return the questionnaire within 14 days after the reminder email, the department will be categorized as non-responding.

Data will be obtained from September 2021-November 2021.

Data processing will be conducted in REDCap from November 2021-Jan 2022.

Data and biological material

The questionnaire will be sent via OPEN and data will be stored in REDCap.

Answers to the questionnaire (appendix 1 and 2) from each ED will be obtained from the person responsible for activating the trigger call, the head of department, a trigger team senior physician and a trigger team nurse.

Data regarding the number of patients received by each ED will be obtained through the database RKKP (Regionernes Kliniske Kvalitetsudviklingsprogram) (14).