Evaluation des intelligenten Assistenzdienstes OPTINOFA zur strukturierten Ersteinschätzung in der Interdisziplinären Notaufnahme
by Malte Hoff
Date of Examination:2023-12-06
Date of issue:2023-11-02
Advisor:Prof. Dr. Sabine Blaschke-Steinbrecher
Referee:Prof. Dr. Sabine Blaschke-Steinbrecher
Referee:Prof. Dr. Dagmar Krefting
Referee:Prof. Dr. Margarete Schön
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EnglishOvercrowding-scenarios in emergency departments are a growing problem in Germany due to a high amount of non-urgent patients. OPTINOFA ("Optimierung der Notfallversorgung durch strukturierte Ersteinschätzung mittels intelligenter Assistenzdienste") is a new digital triage system which aims at solving this problem by providing a structured assessment of patients in emergency departments. Beside determining the treatment urgency, it also recommends the necessary level of care. By this means, patients who do not require care in the emergency department itself can be identified and referred to the statutory health care provider instead. The main goal of OPTINOFA is to reduce outpatient treatments in the emergency department by 30% which means a decreasing proportion from approximately 60% to 51% of all patients. In order to evaluate the efficacy of the tool, a multi-center study is being performed and the given work is an interim evaluation with the data collected in the emergency department of the University Medical Center Göttingen for the main study. In the control period study patients were assigned according to existing procedures, while in the intervention period the OPTINOFA triage was used. Both periods were compared in terms of outpatient treatments, waiting time and length of stay of the study patients. The proportion of outpatient treatments within the group of study patients was reduced significantly from initial 44.35% to 38.82% by using the OPTINOFA triage. This is a reduction of 12.47% and can be seen as a success even though the target of a 30% reduction was not achieved as the proportion of outpatient treatments had already been below the target of 51%. The length of stay did not differ significantly between both periods. While there were significant differences concerning the waiting time in some subgroups, these might be coincidental due to other influencing factors. The COVID-19 pandemic in 2020 can be considered a major influencing factor for the study as it led, for example, to a significantly reduced number of patients during the intervention period. A valid result in terms of outpatient treatments can still be assumed since the distribution of the ESI triage levels for study patients remained the same in both periods. Regarding waiting time and length of stay the effects of the pandemic may have overbalanced the effects of the intervention. In this interim evaluation OPTINOFA tool has turned out to be a promising tool for reducing outpatient treatment in the emergency room. The results of the final evaluation of the entire study period remain to be seen.
Keywords: triage; emergency department; overcrowding