Emergency department patient classification systems: A systematic review

BACKGROUND: The emergency department is a dynamic environment with a high throughput of patients. The clinical stability of patients varies considerably. In order to provide optimal care for patients a responsive staffing pattern is required. There is a need for a valid and reliable, prospective, emergency department patient classification system to set adequate nurse staffing levels in the UK. AIMS AND OBJECTIVES: To conduct a systematic review of the literature and determine the validity, reliability, strengths and weaknesses of emergency department patient classification systems. METHODS: The following electronic databases were searched for years 1985-2004: MEDLINE; CINAHL; COCHRANE Library databases DARE, CDSR, CCTR, BioMedNet Reviews, National Research Register (NRR). Manual searches were also conducted and relevant references retrieved from those listed in key papers, reports, theses and dissertations. Studies were also retrieved by contacting researchers in the field. RESULTS: Twelve patient classification systems met all the inclusion criteria. Only three systems reported evidence of good validity and reliability: the ED Patient Needs Matrix developed in the US, the Conner's Tool (a modified version of the ED Patient Needs Matrix) developed in Australia and the Jones Dependency Tool developed in the UK. CONCLUSION: There are very few patient classification systems developed for use in the ED setting that have demonstrated good validity and reliability. The Jones Dependency Tool is a simple, easy to use prospective, patient classification system that has demonstrated good validity and reliability in the UK.