[Evaluation of the TriageClient digital decision support system for the sectoral allocation of emergency patients in an integrated emergency center : A secondary data analysis].

backgroundIntegrated emergency centers (INZ) in Germany use centralized initial assessment units to triage patients with structured digital tools and allocate them to the appropriate care setting (emergency department vs. out-of-hours primary care clinic). At the University Medical Center Freiburg, an INZ has operated routinely since October 2023. We evaluated the clinical decision support system TriageClient (Blackpine Medical GmbH, Freiburg, Germany) regarding safety, effectiveness, efficiency, and timeliness.

methodsAnonymized routine data of all emergency presentations in 2024 were analyzed. Primary endpoints were 7‑day in-hospital mortality and tracer diagnoses. The secondary endpoint was hospital admission ≥ 24 h. Efficiency was measured as sector switches from the primary care clinic into the emergency department, and effectiveness as concordance with family-practice-sensitive conditions. Noninferiority was assessed against external references. Timeliness was quantified as defects per million opportunities (DPMO) for a triage duration > 10 min.

resultsOf 67,552 presentations, 50,047 (74.1%) self-presenting patients were assessed with TriageClient. Final allocation was 38.5% to the primary care clinic and 61.5% to the emergency department. In Emergency Severity Index (ESI) levels 4/5 and in the primary care sector, mortality and tracer diagnoses were lower than in higher-acuity cohorts. Noninferiority/superiority was achieved for primary endpoints. The secondary endpoint met these criteria only after final nurse allocation. The sector-switch rate was 12.3%. DPMO for triage duration > 10 min was 1.36% (13,573 DPMO).

conclusionDigital initial assessment with TriageClient showed high safety, efficiency, effectiveness, and timeliness in routine INZ operation. Multicenter studies should validate these findings.