HopScore: An Electronic Outcomes-Based Emergency Triage System (Maryland)

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The need for effective triage is escalating, as crowded emergency departments (EDs) are challenged to safely manage excess patient demand with inadequate system capacity. Crowded EDs must maintain systems to quickly differentiate patients with critical conditions from those with less urgent needs. Inability to quickly identify significantly ill patients in crowded EDs contributes to delays in time-sensitive treatment and potentially avoidable deterioration, morbidity, and mortality.

The “HopScore” tool, developed at Johns Hopkins, aims to support objective triage decisions and improve patient differentiation based on outcomes data. HopScore uses easily obtained patient demographic and clinical information commonly collected at ED triage to predict patients’ risk for critical outcomes, including mortality, intensive care unit admission, emergent surgery, cardiac catheterization, and inpatient admission.

This project will compare the HopScore tool to the Emergency Severity Index (ESI), the current standard for ED triage. Although ESI is used by 72 percent of EDs across the United States, it has several deficiencies that HopScore aims to overcome: (1) no link to critical patient outcomes; (2) a strong reliance on triage evaluator’s subjective judgment; and (3) poor discrimination of patients across the five-level index.

The specific aims of the project are as follows:

  • Refine the HopScore decision tree algorithm using three independent population sources. 
  • Design and develop HopScore as a software application that provides swift and interpretable triage decision-support embedded in the ED electronic medical record (EMR) at two clinical sites and as a free-standing, public-facing Web application for general ED use. 
  • Execute a phased implementation of the EMR-embedded HopScore application in clinical practice at both clinical sites. 
  • Prospectively evaluate the HopScore application’s usability and impact on patient and operational outcomes compared to ESI. 

HopScore will be evaluated prospectively with a pre- and post-intervention analysis that will compare the ability of HopScore and ESI to differentiate critical patient outcomes. The hypothesis is that HopScore will reduce delays in care for those most in need in the ED as compared to ESI.

For more information: http://www.pacercenter.org/research/triage-tool-for-accurate-disposition-of-patients-in-disaster-response.aspx.

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HopScore: an electronic outcomes-based emergency triage system - final report

Levin, S. HopScore: an electronic outcomes-based emergency triage system - final report. (Prepared by Johns Hopkins University under Grant No. R21 HS023641). Rockville, MD: Agency for Healthcare Research and Quality, 2018. (PDF, 945.48 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
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