2016 Revisions to the CTAS Guildelines

Since 2008, CTAS has been reviewed and revised on a 4-year cycle. The 2016 revisions have added 3 new CEDIS complaints, integrated components of the Obstetrical Triage and Acuity Scale (OTAS) to align our obstetrical special modifiers where possible and added a postpartum complaint. In addition, we have recognized the importance of the aging demographic and their impact on emergency department visits. Triage decision making in the geriatric population presents unique challenges. The need to identify and adjust to the challenges t has led to the publication of a separate review on applying the CTAS to the geriatric population and a major revision to our educational materials, including the development of a blended online and face to face education program (currently under development).

  • English version 2016 Revision as a direct link to CJEM 2017; 19(S2): S18 – S27
  • English version 2016 Revision as a PDF document of CJEM 2017; 19(S2): S18 – S27
  • English version Applying CTAS to Geriatric Patients as a direct link to CJEM 2017; 19(S2): S28 – S37
  • English version Applying CTAS to Geriatric Patients as a PDF document of CJEM 2017; 19(S2): S28 – S37

2013 Revisions to the CTAS Guidelines

Since the 2008 CEDIS Presenting Complaint and the Adult and Paeds CTAS revisions the focus has been on reviewing and revising the teaching materials and increasing Instructor access across the country. We have received and addressed questions and provided feedback and the 2013 updates reflect some of that feedback, with only a few additions and changes. Keys messages include the recognition that ED overcrowding both increases the need for effective triage, but can also add pressure to triage nurse acuity assignments. The ideal is to ‘stream’ patients to the most appropriate treatment space and not to the waiting room. For adults fever is not defined as >38oC to align with the SIRS criteria definition. For Paeds pulse and respiratory rate assessments new 0 – 2 years graphs have been developed for easier interpretation; Newly born was added as a presenting complaint for babies born in or on the way to the ED; and ‘button battery’ modifiers have been added to several foreign body complaints.

  • English version as a PDF document – ePub document

2008 Revised Paediatric CTAS Implementation Guidelines

Since the original Paeds CTAS Implementation guidelines published in 2001 a standardized CEDIS complaint list was published. A revised CEDIS version in 2008 was published to be more inclusive of the diversity of adult and paediatric presentations and the paediatric complaints were included in the system based list rather than separated. The new implementation guideline clarifies the similarity of the process for adult and paediatric triage while recognizing some of the unique aspects of children’s presentations. The revised guidelines will be incorporated into the new CTAS NWG teaching package and will make it easier to incorporate in a single education format and to implement in emergency department electronic information systems.

  • English version as a direct link to CJEM 2008;10(3):224-232
  • English version as a PDF document of CJEM 2008;10(3):224-232
  • French version as a direct link to CJEM 2008;10(3):233-243
  • French version as a PDF document of CJEM 2008;10(3):233-243

2008 Revised Adult CTAS Implementation Guidelines

In conjunction with the 2008 CEDIS presenting complaint list revisions, the Adult CTAS guidelines have also been revised based on research and stakeholder feedback. To understand the current content and implementation of adult CTAS readers need to include the 2004 guideline revisions as the 2008 manuscript only identifies modifications to the 2004 paper, but does not repeat any of the content that is unchanged. This updated material will be included in the CTAS updated educational package by summer 2008. The supplement (see below under support documents) has also been revised to maintain the link between the CEDIS complaints and the standardized 1st and 2nd order CTAS modifiers in a format supportive of computerization.

  • English version as a direct link to CJEM 2008;10(2):136-142
  • English version as a PDF document of CJEM 2008;10(2):136-142
  • French version as a direct link to CJEM 2008;10(2):143-150
  • French version as a PDF document of CJEM 2008;10(2):143-150

2004 Revised Adult CTAS Implementation Guidelines

Following the publication of the CEDIS presenting complaint list in 2003, experimentation with CTAS electronic decision support, and results of CTAS research the adult guidelines were revised to combine the complaints and standardized CTAS modifiers in a format compatible with computerization.

  • English version as a direct link to CJEM 2004;6(6):421-7
  • English version as a PDF document of CJEM 2004;6(6):421-7
  • French version as a direct link to CJEM 2005;7(1):28-35
  • French version as a PDF document of CJEM 2005;7(1):28-35

2001 Paediatric Implementation Guidelines

Recognizing the special challenges the assessment of children posed CAEP, NENA, and AMUQ combined with the Canadian Paediatric Society to develop the first Paeditric specific guidelines.

  • As a direct link to PaedCTAS (Supplement-English) CJEM 2001;3(4)
  • As a PDF document of CJEM 2001;3(4 suppl)
  • As a direct link ÉTGPédiatrique (supplément français) CJEM 2001;3(4)

1998 CTAS Implementation Guidelines

The original guidelines developed by members of CAEP, NENA, and AMUQ ere the first 5-level triage scale introduced in North America and became the recognized national standard.

  • As a PDF document (158K)
  • The French version as a PDF file (189K)

CTAS Implementation Support Documents

2013 Content Standards linking CEDIS Complaints to related CTAS Modifiers

Excel spreadsheets (Adult and Paediatric) organized into the 17 CEDIS Presenting Complaint categories with individual Complaints listed in alphabetical order by group. The relevant 1st and 2nd order modifiers are provided for each complaint along with the relevant score, codes, and action notes. The 1st order modifiers are defined along with the majority of terms. In addition there is a rule reference key and an abbreviations key. The goal of these documents is to assist programmers wishing to create CTAS clinical decision support within their EDIS product. The pdf document instructs the reader how to use the excel spreadsheets.

For further information please contact ctas@caep.ca

CTAS Complaint Oriented Triage (COT) teaching/reference tool

This Microsoft Powerpoint file transforms the updated Adult and Paediatric CTAS and the CEDIS chief complaints into a single tool that allow users to better understand how to operationalize the revised CTAS. As a user, just choose the complaint category, select the complaint, and then review the relevant modifiers to assign the appropriate triage score. This can be used as an adjunct to teach CTAS or as a user friendly tool in triages that lack informatic resources. The Adult COT has a red background while the Paediatric COT has blue background. This was done in order to avoid confusion between the triage modifiers.

To use the slides properly, view in “slide mode” or Shift+F5. Many of the squares have underlying hyperlinks. MAC users see below.

There will be 4 versions, English Canada and French Canada versions using the numeric coding based on the National Ambulatory Care Reporting System (NACRS) plus English Quebec and French Quebec versions using the Ministère de la Santé et des Services sociaux (MSSS) numeric codes. Below you will find the links for the English Canada version and the Quebec French version. The other versions will be completed soon.

For Microsoft Office 2013 users
Once you have downloaded the COT file, open the file but do not “Enable Editing”. Click on “slide show” then on “from beginning”. Click on the slides to advance until you get to the slide with <17 or >17 From here the file is interactive.

2012 – COT English Canada Version

2008 – COT Quebec French Version

Mac Users may encounter difficulties converting the Windows Powerpoint metafiles when opening the file. See article in MacWorld: Mass convert PowerPoint metafile data by Rob Griffiths, Macworld.com

If you use PowerPoint and receive many presentations from coworkers who use PowerPoint on PCs, you’re probably familiar with the (sometimes agonizingly slow) process of “graphic metafile conversion.” This is something that PowerPoint on the Mac must do to allow you to view and use any graphics embedded by PC users. The problem is that if you do the natural thing — open the presentation and start looking through it slide by slide — this conversion process happens every time you advance to the next slide.

Here are a couple of handy timesavers to spare yourself the annoyance of waiting for the conversion on every slide. Note that these won’t make the process any shorter (the conversion still has to take place), but they will make it much less annoying.

***The first, and simplest, thing to do is to just save the presentation. When you save it, PowerPoint will convert all the graphic metafile at once, during the save operation. Opening the newly-saved presentation will allow you to breeze through all the slides, as the conversion has been done.***

The second option is to switch to the slide sorter view (View -> Slide Sorter), which also forces an all-at-once conversion of the graphics metafiles.

The third method is to hit File -> Print after opening the presentation. Again, the metafile data will all be converted, and you can cancel out of the Print dialog box when it’s done.

If you use the second two options, remember to save the presentation when you’re done, so you won’t have to wait through the conversion again.

Non urgent patient implications

This article concludes that while non urgent patients are not a strain on ED resources as they often don’t require stretchers, it would be unsafe to use triage score to divert patients away as there was a 7.6% admission rate among these patients.