Objective: The Korean Triage and Acuity Scale (KTAS) was implemented in our emergency department (ED) in May 2016 and is fully integrated into the electronic medical record (EMR) system. Our objective was to determine whether the KTAS is associated with changes in admissions to the hospital, admission disposition, inpatient mortality and length of stay (LOS). Design: Quasi-experimental, uncontrolled before-and-after study. Setting: The urban tertiary teaching hospital with 1100 beds and receives approximately annual 90 000 ED visits. Participants: 122 370 patients who visited the ED during the before-and-the after period. Interventions: ED staff were educated on the KTAS for 1 month, after which the KTAS evaluation period began. Admission, disposition, mortality and LOS were compared between the ‘before’ period (1 June 2015 to 30 April 2016) and the ‘after’ period (1 June 2016 to 30 April 2017). Main outcome measures: Admissions to the hospital, admission disposition, inpatient mortality and LOS. Results: A total of 59 220 and 63 150 patients were included in the before-and-after periods of KTAS implementation, respectively. The pattern of admission and disposition changed significantly after implementation of the KTAS. The mean LOS was 343 min (standard deviation [SD] = 432 min) during the before period, which significantly decreased to 289 min (SD = 333 min) after implementation (P < 0.001). The total mortality rate was significantly reduced after implementation of the KTAS (213 (0.36%) vs. 179 (0.28%), P = 0.020). Conclusion: Implementation of the KTAS changed admission and disposition patterns and reduced the LOS and mortality in the ED.

Paek SH, et al. J Korean Med Sci. 2017 Oct;32(10):1576-1580. https://doi.org/10.3346/jkms.2017.32.10.1576

Ketamine is used intramuscularly or intravenously as a sedative when repairing the skin lacerations of children in many emergency departments (EDs). Nitrous oxide (N(2)O) has the advantages of being a sedative agent that does not require a painful injection and that offers shallower levels of sedation and a rapid recovery of mental state. We evaluated the clinical usefulness of N(2)O compared with intravenous ketamine when used for the repair of lacerations in children in the ED. From January to December 2009, we performed a prospective, randomized study at a single academic ED enrolling pediatric patients aged 3 to 10 years who needed primary repair of a laceration wound. The primary outcome was recovery time, which was defined as the time from completion of procedure to recovery of mental state. Other outcomes were sedation depth, pain scale, adverse effects, and satisfaction with sedation. There were 32 children who were randomly assigned. Recovery times were shorter in the N(2)O group compared with those in the ketamine group (median [interquartile range (IQR)], 0.0 minutes, [0.0-4.0 minutes] vs 21.5 minutes [12.5-37.5 minutes], P < 0.05). Sedation levels were deeper in the ketamine group than in the N2O group, but pain scales were comparable between groups. No difference was observed in the satisfaction scores by physicians, parents, or nurses. Nitrous oxide inhalation was preferable to injectable ketamine for pediatric patients because it is safe, allows for a faster recovery, maintains sufficient sedation time, and does not induce unnecessarily deep sedation.