Paramedics and triage: effect of one training session on triage in the emergency department

Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World

As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. During the height of the coronavirus disease-2019 pandemic, the psychological effects of increased demand for emergency nurses coupled with the fear of coronavirus infection exacerbated nursing turnover rates. Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.

Comparison of scenario based triage education by lecture and role playing on knowledge and practice of nursing students

INTRODUCTION

Quick and accurate triage of patients in the emergency department is a key factor for successful management of the emergency situations and ensuring the quality of care. Moreover, triage skills education is one of the important aspects of preparedness of nurses for different emergency situations. The objective of this study was to compare the effect of educating emergency severity index (ESI) triage using lecture and role-playing on the knowledge and practice of nursing students.

METHODS

This experimental study was conducted in the School of Nursing and Midwifery, Tabriz, Iran, in 2016. In this study, 56 nursing students were selected by convenience sampling method and were randomly divided into two groups. Triage scenarios were taught and presented in two ways by using lecture or role-playing method. One month later, the post-test was taken. Data were collected using a questionnaire assessing the knowledge and practice of ESI and were analysed using SPSS (version 21).

RESULTS

The mean knowledge and practice scores in both groups improved significantly (p < 0.05). The post-test score showed a significant difference between the two groups, and the mean score was higher in the role-playing group compared with that of the lecture group (p < 0.05).

DISCUSSION

The results showed the effectiveness of both educational methods on students' learning. However, the role-playing method was more effective than the lecture method and is recommended for triage education. In addition, according to the importance of triage, developing the theoretical and practical education courses for nursing students is recommended.

Can Paramedics Safely Refuse Transport of Non-Urgent Patients?

OBJECTIVE

The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.

METHODS

A narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).

RESULTS

Only 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient's condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.

CONCLUSION

There is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature. Fraess-Phillips AJ . Can paramedics safely refuse transport of non-urgent patients? Prehosp Disaster Med. 2016;31(6):667-674.

A Comparative Study of the Effect of Triage Training by Role-Playing and Educational Video on the Knowledge and Performance of Emergency Medical Service Staffs in Iran

Introduction

Educating emergency medical staffs in triage skills is an important aspect of disaster preparedness. The aim of the study was to compare the effect of role-playing and educational video presentation on the learning and performance of the emergency medical service staffs in Khozestan, Iran

Methods

A total of 144 emergency technicians were randomly classified into two groups. A researcher trained the first group using an educational video method and the second group with a role-playing method. Data were collected before, immediately, and 15 days after training using a questionnaire covering the three domains of demographic information, triage knowledge, and triage performance. The data were analyzed using defined knowledge and performance parameters.

Results

There was no significant difference between the two training methods on performance and immediate knowledge (P = .2), lasting knowledge (P=.05) and immediate performance (P = .35), but there was a statistical advantage for the role-playing method on lasting performance (P = .02).

Conclusion

The two educational methods equally increase knowledge and performance, but the role-playing method may have a more desirable and lasting effect on performance.

AghababaeianH, SedaghatS, TaheryN, Sadeghi MoghaddamA, ManieiM, BahramiN, Araghi AhvaziL. A comparative study of the effect of triage training by role-playing and educational video on the knowledge and performance of emergency medical service staffs in Iran. Prehosp Disaster Med. 2013;28(6):1-5.

A training programme did not increase agreement between allied health clinicians prioritizing patients for community rehabilitation

Objective: To evaluate the effect of formal training on agreement between clinicians making decisions on client priority.

Setting: A centralized intake service receiving referrals for a community rehabilitation programme.

Design: Agreement was measured between the priority categories allocated to consecutive referrals by one of five clinicians in the referral office compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating. Data collection followed the implementation of four 1-hour workshops involving all raters, designed to increase consistency of triage decisions. Results were compared to a previous study conducted prior to the training.

Participants: Two hundred and one consecutive referrals received for community rehabilitation services, triaged by experienced clinicians with allied health or nursing qualifications.

Outcome measure: Agreement using weighted kappa (&kappa;w).

Results: There was no change in agreement between clinicians after training, compared with a previous study in the same setting. Agreement remained moderate (&kappa;w = 0.50), with clinicians disagreeing on approximately 30% of referrals.

Conclusions: Three out of 10 clients will receive a different priority rating and waiting time for rehabilitation services depending on which clinician in the referral office made the rating. This result was not improved by conducting a training programme.

Does nonmedical hospital admission staff accurately triage emergency department patients?

OBJECTIVES

Utilization of hospital emergency departments (EDs) is continuously increasing. Though nurses and physicians are ultimately responsible for the definite triage decisions, initial ED patient triage is frequently performed by hospital admission staff. This study analyzes the quality of assessment of the severity of emergencies and the choice of treatment unit made by hospital admission staff.

METHODS

One thousand fifty-nine consecutive surgical and medical patients entering the ED of the University Hospital Basel during an 11-day period were independently assessed by hospital admission staff without formal medical training, ED nursing staff, and ED physicians. Emergencies were classified by severity (intervention within minutes/hours/days) or by severity and resource utilization (immediate intervention with/without life-threatening condition, delayed intervention with high/low/no demand of resources). Emergency assessment and triage decision (surgical/medical, outpatient/inpatient treatment) were documented independently by all three ED staff groups.

RESULTS

In 64% of the cases, initial assessment by admission staff corresponded with the final assessment by the ED physician. Concordance was, however, poor (kappa=0.23). Underestimation of the severity occurred in 7.5% of cases without severe or lethal consequences. Ninety-four percent of patients were treated in the unit to which they were originally triaged by the admission staff.

CONCLUSION

Triage quality regarding the choice of treatment unit was found to be excellent, whereas the quality of the assessment of the severity of the emergency by nonmedical ED admission staff was acceptable. ED patients have to be assessed by medical staff early after admission to ensure adequate and timely interventions.