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Kalan L, Chahine RA, Lasfer C. The Effectiveness and Relevance of the Canadian Triage System at Times of Overcrowding in the Emergency Department of a Private Tertiary Hospital: A United Arab Emirates (UAE) Study. Cureus 2024; 16:e52921. [PMID: 38406095 PMCID: PMC10894025 DOI: 10.7759/cureus.52921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE A systematic and straightforward triage system is crucial for the proper and timely care of patients within the emergency department (ED). This study unfolds a detailed understanding of the impact of the Canadian Triage and Acuity Scale (CTAS) on patient care and resource allocation in a private tertiary hospital. To the best of our knowledge, this is the only article studying the impact of the CTAS in one of the private hospitals in the United Arab Emirates (UAE) to achieve triage optimisation strategies. There is scope for further research in both public and private hospitals in the UAE. A triage system not only helps healthcare professionals prioritise cases conveniently but also guides patients to the most suitable area for a consultation. As a general rule, EDs follow an algorithm for the purpose of triage, and the aim of our study is to assess one such five-level triage system, CTAS, for its effectiveness and relevance during overcrowding in a UAE ED. METHOD Within a period of approximately three weeks, a total of 351 CTAS-triaged patients were included in a prospective observational study during peak hours (17:00-22:00) of an ED in the UAE. The CTAS app was used as the triage tool to assess relevance, in terms of patient waiting times, resource allocation, and urgency level distribution, to the Canadian scale. All patients presenting to the ED were included with no exclusion criteria. The relationship between urgency level, duration of visit, and resources used was assessed, and the department's triage results were compared with those of the CTAS app. RESULTS Our sample showed a female (187; 53.3%) and adult preponderance (215; 61.3%) with most of the adult patients aged between 30 and 40 (96; 44.65%). 41.5% (145) of the triage was mismatched between the department and the CTAS app with 115 (79.3%) cases of under-triaging and 30 (20.7%) cases of over-triaging. There was a statistically significant difference (p=0.004) between average waiting times across triage categories 4 and 5 with the former category patients waiting for a longer period of time. Cohen's kappa showed moderate inter-relatability (k=0.42). The average utilisation costs per triage category showed a positive correlation with the urgency level for CTAS (Pearson's r=0.59); however, the costs declined as the urgency level rose for the department. CONCLUSIONS The high compliance rate demonstrates that the CTAS can be applicable to institutions outside of Canada. The categorisation of patients by the CTAS and their resource allocation were more accurate than the standard triage proving its effectiveness as a triage tool. Lack of synchronisation among the triage nurses and inadequate triage training are the most plausible reasons for this comparison. The recommended "time to be seen by a physician" was achievable in our ED, and that, along with the expected relationship between CTAS and resource utilisation, can be seen as valid indicators for a quality triage system for use in the UAE.
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Affiliation(s)
- Laila Kalan
- Trauma and Orthopaedics, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Racha A Chahine
- Quality and Risk Management, Fakeeh University Hospital, Dubai, ARE
| | - Chafika Lasfer
- Emergency Medicine, Fakeeh University Hospital, Dubai, ARE
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Gorick H, McGee M, Wilson G, Williams E, Patel J, Zonato A, Ayodele W, Shams S, Di Battista L, Smith TO. Understanding triage assessment of acuity by emergency nurses at initial adult patient presentation: A qualitative systematic review. Int Emerg Nurs 2023; 71:101334. [PMID: 37716173 DOI: 10.1016/j.ienj.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness. AIMS This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation. METHODOLOGY Medline, CINAHL and Academic Search Complete were systematically searched to 15th December 2022. Data were analysed using thematic synthesis. Established themes were reviewed with GRADE-CERQual to evaluate certainty of evidence. RESULTS 28 studies were included in the review. Data analysis uncovered three superordinate themes of holistic reasoning, situational awareness, and informed decision-making. The findings show nurses value holistic assessments over algorithms and rely on knowledge and experience. They also assess the wider situation in the emergency department. CONCLUSIONS This review presents new perspectives on nurses' decision-making processes about patient's acuity. Nurses holistically gather information about patients before translating that information into acuity scores. These actions are informed by their knowledge and experience; however, the wider situation also impacts their decisions. In turn, the nurses use interpretations of patients' acuity to control the wider situation.
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Affiliation(s)
- Hugh Gorick
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom.
| | - Marie McGee
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
| | - Gemma Wilson
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Emma Williams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Jaimik Patel
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Anna Zonato
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Wilfred Ayodele
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Sabina Shams
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Luca Di Battista
- Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Toby O Smith
- University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospitals, Colney Lane, Norwich NR4 7UY, United Kingdom; University of Warwick, Coventry CV4 7AL, United Kingdom
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Anand V, Dey CK, Shukla A, Tp M, T P, Rathia SK, Barman S, Goel AK, Srivastava NK, Meena H. Knowledge, Awareness, and Understanding of Pediatric Triage Among Nursing Officers in India: A Multicenter Study. Cureus 2023; 15:e46102. [PMID: 37900363 PMCID: PMC10611944 DOI: 10.7759/cureus.46102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Triage is crucial in patient screening within emergency departments (EDs) worldwide. It is one of the essential and standard medical practices in many developed countries. However, in India, there is a need for improvement in triage utilization, as it is predominantly performed by resident doctors or medical officers, leading to an uneven distribution of clinical skills among healthcare providers (HCPs). A comprehensive analysis incorporating literature review and data collection revealed that while mandatory screening is conducted in most Indian EDs, the formal implementation of standardized triage protocols remains limited. Like in developed countries, registered nurses or nursing officers (NOs) can be effectively trained and directed to play the role of dedicated triage personnel in EDs of most of the healthcare facilities in India. METHOD AND MATERIALS This study aimed to examine the current state of triage utilization and its impact on the distribution of responsibilities among HCPs in Indian EDs. Through this online survey, the investigators assessed the knowledge and practical understanding of clinical triaging among NOs, working at various hospitals nationwide. RESULTS The participants included 5,029 NOs working in various parts of India, predominantly nursing graduates (82.52%), the majority being employed in government healthcare settings (84.01%) and most having over five years of cumulative working experience in the ED (70.77%). Nurses showed inadequate knowledge and awareness about the Pediatric Assessment Triangle (PAT) used for quick initial evaluation (62.18% among all participants). Concerning the complete triage process applicable, especially in pediatric ED settings, they had even less satisfactory knowledge and understanding, e.g., identifying primary (28.27%) and secondary (22.69%) survey components via focused history and examination, properly using temperature assessment (23.32%) and instant blood glucose level assessment (22.95%) in triage, and knowing various types of internationally accepted triage systems for ED-based health facilities such as the Emergency Severity Index (ESI), Canadian Triage and Acuity Scale (CTAS), and Australasian Triage Scale (ATS) (15.87%). ANOVA and post hoc analysis revealed that the intergroup performance of the study participants with maximum correct responses to the knowledge-determining specified subset of the questionnaire depicts the significantly higher role of graduate nursing degree over diploma such as General Nursing and Midwifery (GNM)/Auxiliary Nursing and Midwifery (ANM) qualification, working in government hospital versus private setup, and ED working experience of >5 years over that of <5 years. CONCLUSIONS Of the participants in the study, 50% were not evaluated for cognitive or psychomotor domains during their assessment examinations. The research illuminated a significant disparity in knowledge and proficiency levels among Indian nurses concerning pediatric triage, especially with the ability to effectively apply the PAT for initial patient evaluations, discern components of primary and secondary surveys, and comprehend various triage systems. This study underscores the importance of comprehensive reform in the Indian healthcare system and teaching curriculum by emphasizing clinical triage training and interprofessional collaboration, and establishing guidelines and regulations to ensure consistent and standardized triage practices across all EDs.
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Affiliation(s)
- Varun Anand
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Raipur, IND
| | - Chandan K Dey
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Raipur, IND
| | - Arvind Shukla
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Murugan Tp
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, IND
| | - Pugazhenthan T
- Department of Pharmacology and Therapeutics, All India Institute of Medical Sciences, Raipur, IND
| | - Santosh K Rathia
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Raipur, IND
| | - Sandeep Barman
- Department of Pediatrics, Nagaon Medical College and Hospital, Nagaon, IND
| | - Anil Kumar Goel
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, IND
| | - Niraj K Srivastava
- Department of General Surgery, All India Institute of Medical Sciences, Raebareli, IND
| | - Harish Meena
- Department of Nursing, All India Institute of Medical Sciences, Raipur, IND
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Griffits S, Hines S, Moloney C. Characteristics and processes of registered nurses' clinical reasoning and factors relating to the use of clinical reasoning in practice: a scoping review. JBI Evid Synth 2023; 21:713-743. [PMID: 36730096 DOI: 10.11124/jbies-21-00373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this review was to examine the characteristics and processes of clinical reasoning used by registered nurses in clinical practice, and to identify factors reported to relate to the use of clinical reasoning by registered nurses in clinical practice. INTRODUCTION Significant variability in the clinical reasoning of graduate registered nurses has been identified in research, with underdeveloped and unsafe clinical reasoning being linked to failure-to-rescue and sentinel events in the clinical setting. The identification of characteristics and processes of clinical reasoning, and factors relating to registered nurses' clinical reasoning when engaged in clinical practice, will increase understanding of the clinical reasoning requirements for undergraduate registered nurses and of potential factors that may affect their clinical reasoning. INCLUSION CRITERIA Studies including registered nurses who met the criteria for registered nurse registration in Australia and who used clinical reasoning to engage with health care consumers in all practice environments were eligible for inclusion. METHODS Eight databases were searched, with articles identified through CINAHL, MedNar, PubMed, Science Direct, ERIC, PsycINFO, Scopus, and ProQuest Dissertations and Theses. Database searches were conducted on December 31, 2020, and updated August 20, 2021, with primary qualitative and quantitative research studies in English from 2000 onwards considered for inclusion. Opinion papers, text, and reports were not included. Data were extracted based on the draft charting tool from the scoping review protocol, with results presented in tabular format and in a narrative summary. RESULTS The 29 qualitative and 5 quantitative research studies included in the scoping review utilized exploratory descriptive, descriptive rationalist, narrative, ethnography, correlational, observational, and grounded theory methodologies in their research designs. Observation, think-aloud sessions, questionnaires, surveys, interviews, and focus groups were used to collect data from the 1099 participants in 9 countries. Multiple concepts related to the characteristics (n=35) and processes (n=30) of clinical reasoning were detected in the research studies, with 5 categories identified: i) situation management, ii) data management, iii) interpreting, iv) implementing and evaluating, and v) professional practice, with an additional processes category identified (decision-making processes). The factors (n=26) reported to relate to clinical reasoning were categorized into environment of care, care requirements, professional practice, experience, knowledge, and decision-making processes. Connections between the various concepts were evident throughout the review. CONCLUSIONS The scoping review identified characteristics and processes of clinical reasoning, as well as factors reported to relate to clinical reasoning in all studies. The concepts that comprise the clinical reasoning of registered nurses in clinical practice must be considered in undergraduate registered nurse education. Registered nurses must complete their baccalaureate program with well-developed clinical reasoning to ensure safe clinical practice. Understanding the characteristics and processes of registered nurses' clinical reasoning in clinical practice, and the factors reported to relate to clinical reasoning, supports the creation of targeted resources for development and assessment of clinical reasoning.
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Affiliation(s)
- Susan Griffits
- School of Nursing and Midwifery, Faculty of Health Engineering and Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Sonia Hines
- College of Medicine and Public Health, Flinders Rural and Remote SA and NT, Alice Springs, NT, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, Faculty of Health Engineering and Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
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Yang J, Wan X, Yu P, Li X. Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey. Int Emerg Nurs 2023; 67:101264. [PMID: 36773513 DOI: 10.1016/j.ienj.2023.101264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/04/2023] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making. METHOD A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form. RESULT Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability. CONCLUSION Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.
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Affiliation(s)
- Jiayi Yang
- The First Hospital of China Medical University, Shenyang 110000, China
| | - Xinli Wan
- Fourth Affiliated Hospital of China Medical University, Shenyang 110000, China
| | - Pengyu Yu
- The People's Hospital Of Liaoning Province, Shenyang 110000, China
| | - Xiaobo Li
- The First Hospital of China Medical University, Shenyang 110000, China.
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Nelson R, Kittel J, Mahoui I, Thornberry D, Dunkman A, Sams M, Adler D, Jones CMC. Racial differences in treatment among patients with acute headache treated in the emergency department and discharged home. Am J Emerg Med 2022; 60:45-49. [DOI: 10.1016/j.ajem.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022] Open
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Establishing Research Priorities for the Emergency Severity Index Using a Modified Delphi Approach. J Emerg Nurs 2021; 47:50-57. [PMID: 33390221 DOI: 10.1016/j.jen.2020.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The accuracy of an initial ED triage decision has been reported to drive the clinical trajectory for ED patients, and, therefore, this assessment is critical to patient safety. The Emergency Severity Index-a 5-point score assigned by a triage nurse and based on disease acuity, patient potential for decompensation, and anticipated resource use-is used both in the United States and internationally. In the US, the Emergency Severity Index is used by up to 94% of the academic medical center emergency departments. In 2020, the Emergency Nurses Association acquired the intellectual property rights to the Emergency Severity Index and is responsible for its maintenance and improvement. OBJECTIVE The purpose of this study was to establish a research agenda for the improvement of individual and institutional understanding and use of the Emergency Severity Index. METHODS Modified Delphi process was used with 3 rounds of data collection. RESULTS Round 1 yielded 112 issues, which were collapsed into 18 potential research questions in 4 general categories: education and training (6 questions), workplace environment (3 questions), emergency care services (7 questions), and special populations (2 questions). These questions were used in round 2 to establish importance. Round 3 yielded a rank ordering of both categories and research questions. DISCUSSION The research priorities as set through the use of this modified Delphi process align well with current gaps in the literature. Research in these areas should be encouraged to improve the understanding of educational, environmental, and process challenges to emergency nurses' triage decisions and accuracy of Emergency Severity Index assignments.
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Gold A, Greenberg B, Strous R, Asman O. When do caregivers ignore the veil of ignorance? An empirical study on medical triage decision-making. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:213-225. [PMID: 33398490 PMCID: PMC7781192 DOI: 10.1007/s11019-020-09992-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations ("worst-first"). This study empirically examined the influence of value-oriented considerations on medical triage decision-making. Participants were asked to prioritize medical treatment relating to four case scenarios of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution.In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual ("victim-first").Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed.
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Affiliation(s)
- Azgad Gold
- Forensic Psychiatry Unit, Yehuda Abarbanel Mental Health Center, Bat Yam, Israel
| | - Binyamin Greenberg
- Adolescent Psychiatry Department, Beer Yaakov-Ness Ziona Mental Health Center, Beer Yaakov, Israel
| | - Rael Strous
- Psychiatry Department, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Oren Asman
- Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
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Kim HJ, Kang HY, Kim HR. Development of a Web-Based Korean Triage and Acuity Scale Learning Program for Emergency Department Nurses. Comput Inform Nurs 2021; 39:821-827. [PMID: 34747898 DOI: 10.1097/cin.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Korean Triage and Acuity Scale is a tool developed to classify severity and urgency of emergency department patients, focusing on their symptoms. Considering the importance of the Korean Triage and Acuity Scale, learning for emergency department nurses who perform the Korean Triage and Acuity Scale must be structured to ensure that the knowledge they gain can be applied to various clinical situations of the emergency department. Moreover, Web-based learning is considered appropriate in this situation. This is a methodological research study that was conducted to develop a Web-based Korean Triage and Acuity Scale learning program for emergency department nurses. The learning program was developed using each of the five phases of the "analysis, design, development, implementation, and evaluation" model, that is, analysis, design, development, implementation, and evaluation. The learning program was composed of 22 cases of emergency situations based on the Korean Triage and Acuity Scale teaching material with an approval from the Korean Triage and Acuity Scale committee in the Korean Society of Emergency Medicine. The developed program was delivered in 4-hour sessions over 4 weeks. Emergency department nurses who were given the Web-based Korean Triage and Acuity Scale learning program showed improvement in work-site transfer and reported satisfactory learning. The findings indicate that the Web-based learning program for nurses can be used as an effective tool that is easily accessible and provides multiple learning opportunities.
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Affiliation(s)
- Hyo-Jin Kim
- Author Affiliations: Department of Nursing, Donggang University (Dr H.-J. Kim); and Department of Nursing, Chosun University (Drs Kang and H.-R. Kim), Gwangju, South Korea
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Improving ED Emergency Severity Index Acuity Assignment Using Machine Learning and Clinical Natural Language Processing. J Emerg Nurs 2020; 47:265-278.e7. [PMID: 33358394 DOI: 10.1016/j.jen.2020.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Triage is critical to mitigating the effect of increased volume by determining patient acuity, need for resources, and establishing acuity-based patient prioritization. The purpose of this retrospective study was to determine whether historical EHR data can be used with clinical natural language processing and machine learning algorithms (KATE) to produce accurate ESI predictive models. METHODS The KATE triage model was developed using 166,175 patient encounters from two participating hospitals. The model was tested against a random sample of encounters that were correctly assigned an acuity by study clinicians using the Emergency Severity Index (ESI) standard as a guide. RESULTS At the study sites, KATE predicted accurate ESI acuity assignments 75.7% of the time compared with nurses (59.8%) and the average of individual study clinicians (75.3%). KATE's accuracy was 26.9% higher than the average nurse accuracy (P <.001). On the boundary between ESI 2 and ESI 3 acuity assignments, which relates to the risk of decompensation, KATE's accuracy was 93.2% higher, with 80% accuracy compared with triage nurses 41.4% accuracy (P <.001). DISCUSSION KATE provides a triage acuity assignment more accurate than the triage nurses in this study sample. KATE operates independently of contextual factors, unaffected by the external pressures that can cause under triage and may mitigate biases that can negatively affect triage accuracy. Future research should focus on the impact of KATE providing feedback to triage nurses in real time, on mortality and morbidity, ED throughput, resource optimization, and nursing outcomes.
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Delmas P, Fiorentino A, Antonini M, Vuilleumier S, Stotzer G, Kollbrunner A, Jaccard D, Hulaas J, Rutschmann O, Simon J, Hugli O, Gilart de Keranflec'h C, Pasquier J. Effects of environmental distractors on nurse emergency triage accuracy: a pilot study protocol. Pilot Feasibility Stud 2020; 6:171. [PMID: 33292718 PMCID: PMC7648299 DOI: 10.1186/s40814-020-00717-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/design A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A, noise; B, task interruptions; C, noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within 2 h. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion Study results will inform the design of large-scale investigations and will help identify teaching, training, and research areas that require further development.
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Affiliation(s)
- Philippe Delmas
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Matteo Antonini
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Guy Stotzer
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Aurélien Kollbrunner
- La Source School of Nursing, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Dominique Jaccard
- School of Management and Engineering Vaud, Yverdon-les-Bains, Switzerland
| | - Jarle Hulaas
- School of Management and Engineering Vaud, Yverdon-les-Bains, Switzerland
| | | | - Josette Simon
- Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Charlotte Gilart de Keranflec'h
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Jérome Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Sutriningsih A, Wahyuni CU, Haksama S. Factors affecting emergency nurses' perceptions of the triage systems. J Public Health Res 2020; 9:1808. [PMID: 32728554 PMCID: PMC7376454 DOI: 10.4081/jphr.2020.1808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Emergency services use a triage system to prioritize patients according to their level of diagnosis. Triage is one of the mandated skills to be owned by an emergency unit nurse. This research aims to identify factors affecting emergency nurses’ perceptions of the triage systems. Design and Methods: 90 nurses were chosen based on quota sampling. Data were analyzed using Chi Square test (α 0.05) and logistic regression analysis. Results: The results show that nurses perceptions were influenced by knowledge (p = 0.017), working experience (p = 0.023), and training (p = 0.041). The factor that had the strongest influence in the formation of nurses’ perceptions was knowledge (p = 0.020 and OR = 3.19). Conclusions: It can be concluded that knowledge, working experience and training influenced emergency nurses’ perceptions on triage systems. Significance for public health Emergency nurses with many years of experience possess abilities to carry out emergency tasks with determined results. Triage is one of the mandated skills needed by emergency nurses to conduct rapid assessments, patient categorization, and allocation. Nurses have capacities to prioritize patient care based on triage decision making. This study identifies factors affecting emergency nurses’ perceptions of the triage systems.
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Affiliation(s)
- Ani Sutriningsih
- Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya
| | | | - Setya Haksama
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Lam RPK, Kwok SL, Chaang VK, Chen L, Lau EHY, Chan KL. Performance of a three-level triage scale in live triage encounters in an emergency department in Hong Kong. Int J Emerg Med 2020; 13:28. [PMID: 32522272 PMCID: PMC7288528 DOI: 10.1186/s12245-020-00288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background Despite its continued use in many low-volume emergency departments (EDs), 3-level triage systems have not been extensively studied, especially on live triage cases. We have modified from the Australasian Triage Scale and developed a 3-level triage scale, and sought to evaluate its validity, reliability, and over- and under-triage rates in real patient encounters in our setting. Method This was a cross-sectional study in a single ED with 24,000 attendances per year. At triage, each patient was simultaneously assessed by a triage nurse, an adjudicator (the “criterion standard”), and a study nurse independently. Predictive validity was determined by comparing clinical outcomes, such as hospitalization, across triage levels. The discriminating performance of the triage tool in identifying patients requiring earlier medical attention was determined. Inter-observer reliability between the triage nurse and criterion standard, and across providers were determined using kappa statistics. Results In total, 453 triage ratings of 151 triage cases, involving 17 ED triage nurses and 57 nurse pairs, were analysed. The proportion of hospital admission significantly increased with a higher triage rating. The performance of the scale in identifying patients requiring earlier medical attention was as follows: sensitivity, 68.2% (95% CI 45.1–86.1%); specificity, 99.2% (95% CI 95.8–100%); positive predictive value, 93.8% (95% CI 67.6–99.1%); and negative predictive value, 94.8% (95% CI 90.8–97.1%). The over-triage and under-triage rates were 0.7% and 4.6%, respectively. Agreement between the triage nurse and criterion standard was substantial (quadratic-weighted kappa = 0.76, 95% CI, 0.60–0.92, p < 0.001), so was the agreement across nurses (quadratic-weighted kappa = 0.81, 95% CI 0.65–0.97, p < 0.001). Conclusions The 3-level triage system appears to have good validity and reasonable reliability in a low-volume ED setting. Further studies comparing 3-level and prevailing 5-level triage scales in live triage encounters and different ED settings are warranted.
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Affiliation(s)
- Rex Pui Kin Lam
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, 1 Nam Fung Path, Wong Chuk Hang, Hong Kong Special Administrative Region, China. .,Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 514, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China.
| | - Shing Lam Kwok
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, 1 Nam Fung Path, Wong Chuk Hang, Hong Kong Special Administrative Region, China.,Present address: 24-hour Urgent Care Center, Tseun Wan Adventist Hospital, 199 Tseun King Circuit, Tseun Wan New Territories, Hong Kong
| | - Vi Ka Chaang
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 514, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Lujie Chen
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 514, 5/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Patrick Mansion Building, 7 Sassoon Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kin Ling Chan
- 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, 1 Nam Fung Path, Wong Chuk Hang, Hong Kong Special Administrative Region, China
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Experiences of nurses working in a triage area: An integrative review. Aust Crit Care 2020; 33:567-575. [PMID: 32143883 DOI: 10.1016/j.aucc.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of the study is to review the literature on the experiences of nurses working in triage within emergency departments in hospitals. REVIEW METHOD This is an integrative review based on Cooper's five-stage framework. DATA SOURCES Primary research articles published from January 2008 to January 2018 were identified from seven databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane, ProQuest, and Scopus. A manual search of the end references from the published studies was also conducted to ensure a comprehensive search. REVIEW METHOD The included studies were evaluated independently by two authors based on the Joanna Briggs Institute appraisal checklist for Interpretive and Critical Research and Descriptive/Case Series to ensure methodological rigour and validity of the review. RESULTS The literature review included 35 articles; of which, 18 were qualitative studies, 13 were quantitative studies, and four were mixed-method studies. The findings from this review were categorised into three themes: (1) making judgement, (2) service delivery, and (3) effective communication. CONCLUSIONS The results from the review suggest that triage is a complex process involving decision-making and interprofessional communication. Nurses need to make judgement, consider factors affecting service delivery, and engage in effective communication, which is central to triaging. Decision-making is contextual and requires judicious judgement. Effective communication with fellow healthcare personnel and with patients and their caregivers is paramount to optimise care delivery. Finally, more support is needed to empower the nurses to cope with the work involved in triaging.
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Triage emergency nurse decision-making: Incidental findings from a focus group study. Int Emerg Nurs 2019; 48:100791. [PMID: 31494074 DOI: 10.1016/j.ienj.2019.100791] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Emergency Department (ED) triage decision-making is a complex process. Triage scales are used to determine patient acuity level, however, they do not provide information on how nurses make triage decisions. This focus group study was part of a larger project to develop a psychometrically sound instrument to measure triage decision-making by nurses; the Triage Decision-Making Instrument. We report important incidental findings that emerged during the study that the participants identified as factors impeding triage decision-making. METHODS Three focus groups were conducted with 11 triage Registered Nurses. They commented on the instrument items and identified factors that influence triage decision-making. Transcripts were analyzed using thematic analysis. RESULTS Three powerful inter-related themes emerged central to encumbering triage decision-making: competing systems (pre-hospital versus the ED), fluctuating patient volume resulting in 'intra-Canadian Triage and Acuity Scale' triaging, and personal capacity including experience and 'triage fatigue'. DISCUSSION The findings demonstrate how interrelated system factors impede nurses triage decision-making. Triage nurses require support in their role and initiatives are needed to reduce the pressure they feel in relation to resolving system issues. Larger system issues and the capacity of the individual decision-makers must be accounted for within the context of increasing effectiveness and safety of ED triage.
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Kim HJ, Kang HY. Effects of a Web-Based Korean Triage and Acuity Scale Learning Program on Triage Self-Efficacy and Triage Performance Ability for Nurses in Emergency Department. J Korean Acad Nurs 2019; 49:171-180. [DOI: 10.4040/jkan.2019.49.2.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Hyo-Jin Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Hee-Young Kang
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
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Sherafat A, Vaezi A, Vafaeenasab M, Ehrampoush M, Fallahzadeh H, Tavangar H. Responsibility-Evading Performance: The Experiences of Healthcare Staff about Triage in Emergency Departments: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:379-386. [PMID: 31516525 PMCID: PMC6714131 DOI: 10.4103/ijnmr.ijnmr_217_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Correct triage is one of the most important issues in delivering proper healthcare in the emergency department. Despite the availability of various triage guidelines, triage is not still appropriately implemented. Therefore, this study was conducted to investigate the role of different underlying factors in triaging emergency patients through a qualitative approach. Materials and Methods: This study was conducted by conventional content analysis. For this purpose, 30 interviews were conducted with 25 participants. The participants included triage nurses, emergency general physicians, emergency medicine specialists, and expert managers at different position rankings in hospitals and educational and administrative centers in Yazd, selected by purposeful sampling. Data were collected through in-depth and unstructured interviews from April 2017 to January 2018, and then analyzed by inductive content analysis. Results: Four categories of profit triage, exhibitive triage, enigmatic, and tentative performance triage were drawn from the data, collectively comprising the main theme of responsibility-evading performance. Conclusions: The dominant approach to the triage in the emergency departments in a central city of Iran is responsibility evasion; however, the triage is performed tentatively, especially in critical cases. To achieve a better implementation of triage, consideration of the underlying factors and prevention of their involvement in triage decision-making is necessary.
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Affiliation(s)
- Asghar Sherafat
- Department of Health in Disaster and Emergency, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Aliakbar Vaezi
- Department of Nursing, School of Nursing and Midwifery, Research Center for Nursing and Midwifery Care in Family Health, Shahid Sadughi University of Medical Science, Yazd, Iran
| | - Mohammadreza Vafaeenasab
- Physiatrist, Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammadhassan Ehrampoush
- Department of Environmental Health Engineering, Environmental Sciences and Technology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Tavangar
- Department of Nursing Education, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Lampi M, Junker JPE, Tabu JS, Berggren P, Jonson CO, Wladis A. Potential benefits of triage for the trauma patient in a Kenyan emergency department. BMC Emerg Med 2018; 18:49. [PMID: 30497397 PMCID: PMC6267912 DOI: 10.1186/s12873-018-0200-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improved trauma management can reduce the time between injury and medical interventions, thus decreasing morbidity and mortality. Triage at the emergency department is essential to ensure prioritization and timely assessment of injured patients. The aim of the present study was to investigate how a lack of formal triage system impacts timely intervention and mortality in a sub-Saharan referral hospital. Further, the study attempts to assess potential benefits of triage towards efficient management of trauma patients in one middle income country. METHODS A prospective descriptive study was conducted. Adult trauma patients admitted to the emergency department during an 8-month period at Moi Teaching and Referral Hospital in Eldoret, Kenya, were included. Mode of arrival and vital parameters were registered. Variables included in the analysis were Injury Severity Score, time before physician's assessment, length of hospital stay, and mortality. The patients were retrospectively categorized according to the Rapid Emergency Triage and Treatment System (RETTS) from patient records. RESULTS A total of 571 patients were analyzed, with a mean Injury Severity Score of 12.2 (SD 7.7) with a mean length of stay of 11.6 (SD 18.3) days. The mortality rate was 1.8%. The results obtained in this study illustrate that trauma patients admitted to the emergency department at Eldoret are not assessed in a timely fashion, and the time frame recommendations postulated by RETTS are not adhered to. Assessment of patients according to the triage algorithm used revealed a significantly higher average Injury Severity Score in the red category than in the other color categories. CONCLUSION The results from this study clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. This is further demonstrated by the retrospective triage classification of patients, which identified patients with high ISS as in urgent need of care. Since no significant difference in to time to assessment regardless of injury severity was observed, the need for a well-functioning triage system is apparent.
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Affiliation(s)
- Maria Lampi
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Johan P. E. Junker
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - John S. Tabu
- Department of Disaster Risk Management, Moi University College of Health and Science, Eldoret, Kenya
| | - Peter Berggren
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Wladis
- Center for Disaster Medicine and Traumatology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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19
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Triage education in rural remote settings: A scoping review. Int Emerg Nurs 2018; 43:119-125. [PMID: 30424946 DOI: 10.1016/j.ienj.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Triage is a complex nursing task to prioritise patient care, based on acuity. Triage decisions can affect patient safety and must employ critical thinking. Graduate registered nurses are expected to triage in rural facilities, which is in contrast to current guidelines. The purpose of this review was; to discover how effective education support programs were in developing clinical decision-making skills for graduates at triage; and to determine what is known about triage education support programs for graduate or novice registered nurses undertaking triage in rural and remote settings. METHOD A scoping review was undertaken to identify and analyse primary research articles following PRISMA guidelines, sourced from four electronic databases. RESULTS 6158 retrieved articles were found, after duplicate removal and screening against inclusion/exclusion criteria; fourteen articles were included. Themes included 'variability of triage accuracy and assessment'; 'education qualifications and experience'; and 'training and supervision'. CONCLUSION This review demonstrates significant gaps in the literature reporting on this topic area, particularly in the rural context. Common recommendations include standardised triage education strategies, and strategies that account for differences in resourcing levels. Further research is required to attempt to link education strategies in rural contexts to acceptable triage outcomes like triage accuracy.
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Singh VK, Shrivastava U, Bouayad L, Padmanabhan B, Ialynytchev A, Schultz SK. Machine learning for psychiatric patient triaging: an investigation of cascading classifiers. J Am Med Inform Assoc 2018; 25:1481-1487. [PMID: 30380082 PMCID: PMC6213089 DOI: 10.1093/jamia/ocy109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Develop an approach, One-class-at-a-time, for triaging psychiatric patients using machine learning on textual patient records. Our approach aims to automate the triaging process and reduce expert effort while providing high classification reliability. Materials and Methods The One-class-at-a-time approach is a multistage cascading classification technique that achieves higher triage classification accuracy compared to traditional multiclass classifiers through 1) classifying one class at a time (or stage), and 2) identification and application of the highest accuracy classifier at each stage. The approach was evaluated using a unique dataset of 433 psychiatric patient records with a triage class label provided by "I2B2 challenge," a recent competition in the medical informatics community. Results The One-class-at-a-time cascading classifier outperformed state-of-the-art classification techniques with overall classification accuracy of 77% among 4 classes, exceeding accuracies of existing multiclass classifiers. The approach also enabled highly accurate classification of individual classes-the severe and mild with 85% accuracy, moderate with 64% accuracy, and absent with 60% accuracy. Discussion The triaging of psychiatric cases is a challenging problem due to the lack of clear guidelines and protocols. Our work presents a machine learning approach using psychiatric records for triaging patients based on their severity condition. Conclusion The One-class-at-a-time cascading classifier can be used as a decision aid to reduce triaging effort of physicians and nurses, while providing a unique opportunity to involve experts at each stage to reduce false positive and further improve the system's accuracy.
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Affiliation(s)
- Vivek Kumar Singh
- Information Systems and Decision Sciences, MUMA College of Business, University of South Florida, Tampa, Florida, USA
| | - Utkarsh Shrivastava
- Haworth College of Business, Department of Business Information Systems, Western Michigan University, Kalamazoo, Michigan, USA
| | - Lina Bouayad
- College of Business, Information Systems and Business Analytics, Florida International University, Miami, Florida, USA
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, Florida, USA
| | - Balaji Padmanabhan
- Information Systems and Decision Sciences, MUMA College of Business, University of South Florida, Tampa, Florida, USA
| | - Anna Ialynytchev
- HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital, Tampa, Florida, USA
| | - Susan K Schultz
- James A. Haley Veterans Hospital, Geriatric Psychiatry, Tampa, Florida, USA
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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Petruniak L, El-Masri M, Fox-Wasylyshyn S. Exploring the Predictors of Emergency Department Triage Acuity Assignment in Patients With Sepsis. Can J Nurs Res 2018; 50:81-88. [DOI: 10.1177/0844562118766178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and purposeEvidence suggests that septic patients, who require prompt medical attention, may be undertriaged, resulting in delayed treatment. The purpose of this study was to examine patient and contextual variables that contribute to high- versus low-acuity triage classification of patients with sepsis.MethodsData were abstracted from the medical records of 154 adult patients with sepsis admitted to hospital through a Canadian Emergency Department. Logistic regression was used to explore the predictors of triage classification.ResultsLanguage barriers or chronic cognitive impairment (odds ratio 5.7; 95% confidence interval 2.15, 15.01), acute confusion (odds ratio 3.4; confidence interval 1.3, 8.2), unwell appearance (odds ratio 3.4; 95% confidence interval 1.7, 7.0), and hypotension (odds ratio 0.98; confidence interval 0.96, 1.0) were predictive of higher acuity classification. Temperature, heart rate, respiratory rate, and contextual factors were not related to triage classification.ConclusionsSeveral patient-related factors were related to triage classification. However, the finding that temperature and heart and respiratory rates were not related to triage classification was troubling. Our findings point to a need for enhanced education for triage nurses regarding the physiological indices of sepsis. The sensitivity of the Canadian Triage Assessment Scale, used in Canadian Emergency Rooms, also needs to be examined.
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Affiliation(s)
- Leon Petruniak
- London Health Sciences Centre, Victoria Adult Emergency Department, London, Ontario, Canada
| | - Maher El-Masri
- Toldo Heath Education, University of Windsor, Windsor, Ontario, Canada
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Triaging the Emergency Department, Not the Patient: United States Emergency Nurses’ Experience of the Triage Process. J Emerg Nurs 2018; 44:258-266. [DOI: 10.1016/j.jen.2017.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 11/20/2022]
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Wolf LA, Perhats C, Delao AM, Clark PR, Moon MD, Zavotsky KE. Assessing for Occult Suicidality at Triage: Experiences of Emergency Nurses. J Emerg Nurs 2018; 44:491-498. [PMID: 29502904 DOI: 10.1016/j.jen.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/05/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Screening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately. METHODS Qualitative exploratory study using focus-group data. FINDINGS Effective and accurate suicidality assessment occurs not by asking a single question but also with the assessment of patient behaviors and presentation (appearance, hygiene, etc). When emergency nurses suspected occult suicidality, additional actions (finding private space, keeping patients safe, and passing on information), took priority. DISCUSSION The Joint Commission recommends using clinical judgment tools for the final determination of safety for a patient at suspected risk of suicide, as research findings suggest that a screening tool can identify persons at risk for suicide more reliably than a clinician's personal judgment. Our participants report that when they assessed suicide risk at triage, it was usually by asking a single question such as "Do you have thoughts or plans to harm yourself?" and they expressed concern about the effectiveness of doing so. Participants described their efforts to improve suicide screening across the duration of the patient's ED stay through an iterative process of assessment that included further probing and eliciting, evaluating, and reacting to the patient's response.
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Affiliation(s)
- Lisa A Wolf
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ.
| | - Cydne Perhats
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Altair M Delao
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Paul R Clark
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
| | - Michael D Moon
- Des Plaines, IL; Louisville, KY; San Antonio, TX; New Brunswick, NJ
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Can Team Triage Improve Patient Flow in the Emergency Department? A Systematic Review and Meta-Analysis. Adv Emerg Nurs J 2017; 38:233-50. [PMID: 27482995 DOI: 10.1097/tme.0000000000000113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This systematic review was performed as a feasibility study for revamping the triage service of an emergency department (ED) in a district hospital. In view of the overcrowding problem that plagues EDs worldwide, we reviewed evidence from randomized controlled trials (RCTs) to determine whether ED team triage improves patient flow in comparison with single-nurse triage. We measured improvement in patient flow in terms of the reduction in length of stay (LOS) or wait time (WT) for all ED patients. Adopting the Cochrane methodology, we searched and evaluated data sources for RCTs comparing patients assessed by an ED triage team, with patients receiving single-nurse triage at the same site. The data extracted were independently reviewed by 2 authors for inclusion and quality assessment. As for risk of bias across studies, there was an overall assessment of every outcome across the included studies according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria for RCTs. In total, 2,164 studies were identified and 2,106 were excluded on the basis of title/abstract, leaving 58 articles for full assessment. Four trials (all cluster RCTs) involving 14,772 patients (165 clusters) met the inclusion criteria. On the basis of our analysis, there was no statistically significant or clinically relevant reduction of LOS and WT for all patients in these studies. One study reported death as an outcome: Relative risk was 0.34 (95% CI [0.01, 8.24]), which suggested that team triage might reduce mortality. Overall, although we have found no conclusive evidence from RCTs to support the use of team triage for improving patient flow in the ED, the results need not deter nursing managers intending to introduce team triage for improving the morale of the triage nurse. However, they may need to consider economic and organizational factors, such as resource reallocation and staff receptiveness, in implementing the new practice.
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Mirhaghi A, Heydari A, Ebrahimi M, Noghani Dokht Bahmani M. Nonemergent Patients in the Emergency Department: An Ethnographic Study. Trauma Mon 2016; 21:e23260. [PMID: 28180119 PMCID: PMC5282938 DOI: 10.5812/traumamon.23260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/01/2014] [Accepted: 12/10/2014] [Indexed: 11/16/2022] Open
Abstract
Background Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. Nonemergent ED visits have been accompanied by ethical and legal conflicts. Objectives The aim of this study was to gain an understanding of ED nurses’ practice regarding triage of nonemergent patients. Patients and Methods Focused micro-ethnography based on Spradley’s developmental research sequence (DRS) was used. This study was conducted in an emergency department. Data was collected through complete participant observations along with formal and informal interviews, and then analyzed using DRS. Results Nine key informants were interviewed formally. Four main categories emerged from the nurses’ culture: nonemergent patient as an uninvited guest, nonemergent patient as an elephant in a dark room, nonemergent patient as an aggressive client, and being nonemergency unless at risk of death. Conclusions Providing care in the emergency department is significantly affected by nonemergent patients, as the emergency department is a place for critically ill patients thus awareness training program is recommended.
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Affiliation(s)
- Amir Mirhaghi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Abbas Heydari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Abbas Heydari, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-513859151, Fax: +98-5138539775, E-mail:
| | - Mohsen Ebrahimi
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohsen Noghani Dokht Bahmani
- Department of Social Sciences, Faculty of Letters and Humanities, Ferdowsi University of Mashhad, Mashhad, IR Iran
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Chang W, Liu HE, Goopy S, Chen LC, Chen HJ, Han CY. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses. Clin Nurs Res 2016; 26:651-666. [PMID: 26935346 DOI: 10.1177/1054773816636360] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.
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Affiliation(s)
- Wen Chang
- 1 Chang Gung University of Science and Technology, Taiwan, ROC.,2 Chang Gung University, Taiwan, ROC
| | | | | | | | - Hsiao-Jung Chen
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
| | - Chin-Yen Han
- 1 Chang Gung University of Science and Technology, Taiwan, ROC
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Bambi S, Ruggeri M, Sansolino S, Gabellieri M, Tellini S, Giusti M, Ciulli E, Franchi F, Petrocchi L, Olivi M, Gravili RC, Biancalana P, Millanti A, Martini L, Sgrevi P. Emergency department triage performance timing. A regional multicenter descriptive study in Italy. Int Emerg Nurs 2016; 29:32-37. [PMID: 26796287 DOI: 10.1016/j.ienj.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions. METHODS This is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system. The sample was made up of 1/3 of nurses working in each ED. Sampling was performed by a stratified proportional randomization (length of service classes: <5 years; 5-10 years; >10 years). Triage nurses were observed during their triage work-shift. RESULTS In 2014, 120 nurses were observed, during 1114 triage processes. The timings of triage phases were: waiting time to triage, median 2.55 min (IQR 1.28-5.03 min; range 0.1-56.25 min); triage duration, median 2.58 min (IQR 1.36-4.35 min; range 0.07-50 min). 400 interruptions were recorded (35.9%). In 9.9% there were 2 interruptions at least. There were significant differences in the medians of triage duration among the years of nurses' triage experience (P < 0.001). The presence of interruption was significantly associated with the increasing of the time intervals in all the triage phases (P < 0.0001). Finally, we recorded significant differences in all the triage time phases between the EDs. CONCLUSION We found that the nurses triage time performances are similar to other triage systems in the world.
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Affiliation(s)
- Stefano Bambi
- Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Marco Ruggeri
- Emergency Department, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Sandra Sansolino
- Intensive Care Unit, Azienda Ospedaliera di Perugia, Piazzale Menghini, 1 - 06156 Sant'Andrea delle Fratte, Perugia, Italy
| | - Massimo Gabellieri
- Emergency Department, Ospedale Santa Maria Nuova, ASF, piazza Santa Maria Nuova n.1 50122, Florence, Italy
| | - Sabrina Tellini
- Emergency Department, Stabilimento Ospedaliero Nottola - AUSL 7 di Siena, piazzale Rosselli, 26 - 53100, Siena, Italy
| | - Monica Giusti
- Emergency Department, Ospedale Santa Maria Annunziata, ASF, Ponte a Niccheri, 58, Via dell'Antella, 50012 - Bagno a Ripoli, Florence, Italy
| | - Elisa Ciulli
- Emergency Department, Ospedale Santa Maria Annunziata, ASF, Ponte a Niccheri, 58, Via dell'Antella, 50012 - Bagno a Ripoli, Florence, Italy
| | - Federica Franchi
- Emergency Department, Ospedale Unico della Versilia, USL 12 Viareggio, via Aurelia sud 312 55041 - Lido di Camaiore, Lucca, Italy
| | - Laura Petrocchi
- Emergency Department, Ospedale della Misericordia, ASL 9 Via Cimabue 152, 58100 Grosseto, Italy
| | - Mauro Olivi
- Emergency Department, Azienda Universitaria Ospedaliera Senese Le Scotte, viale Bracci 14, 53100 Siena, Italy
| | - Raffaele Carlo Gravili
- Emergency Department, Presidio Ospedaliero S. Luca, AUSL 2 Lucca, Via Guglielmo Lippi Francesconi, 55100 Lucca, Italy
| | - Paola Biancalana
- Emergency Department, Presidio Ospedaliero S. Luca, AUSL 2 Lucca, Via Guglielmo Lippi Francesconi, 55100 Lucca, Italy
| | - Andrea Millanti
- Emergency Department, Ospedale San Jacopo, AUSL 3 di Pistoia, via Ciliegiole 97, 51100 Pistoia, Italy
| | - Luca Martini
- Emergency Department, Alta Valdelsa, AUSL 7 Poggibonsi, Siena, 53036 Siena, Italy
| | - Paola Sgrevi
- Emergency Department, Ospedale Nuovo del Mugello, ASF, Viale Resistenza, 60 - 50032 Borgo San Lorenzo, Florence, Italy
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Brown AM, Clarke DE, Spence J. Canadian Triage and Acuity Scale: testing the mental health categories. Open Access Emerg Med 2015; 7:79-84. [PMID: 27147893 PMCID: PMC4806810 DOI: 10.2147/oaem.s74646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The study tested the inter-rater reliability and accuracy of triage nurses' assignment of urgency ratings for mental health patient scenarios based on the 2008 Canadian Triage and Acuity Scale (CTAS) guidelines, using a standardized triage tool. The influence of triage experience, educational preparation, and comfort level with mental health presentations on the accuracy of urgency ratings was also explored. METHODS Study participants assigned urgency ratings to 20 mental health patient scenarios in randomized order using the CTAS. The scenarios were developed using actual triage notes and were reviewed by an expert panel of emergency and mental health clinicians for face and content validity. RESULTS The overall Fleiss' kappa, the measure of inter-rater reliability for this sample of triage nurses (n=18), was 0.312, representing only fair albeit statistically significant (P<0.0001) agreement. Kendall's coefficient of concordance for the sample was calculated to be 0.680 (P<0.0001), which signifies moderate agreement. Although the sample reported high levels of education, comfort with mental health presentations, and experience, accuracy in urgency ratings measured by the percentage of correct responses ranged from 0.05% to 94% (mean: 54%). Greater accuracy in urgency ratings was recorded for triage nurses who used second-order modifiers and avoided the use of override. CONCLUSION Specific focus on the use of second-order modifiers in orientation and ongoing education of triage nurses may improve the reliability and validity of the CTAS when used to assign urgency ratings to mental health presentations.
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Affiliation(s)
- Anne-Marie Brown
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Diana E Clarke
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Julia Spence
- St Michael’s Hospital, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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ten Ham W, Ricks EJ, van Rooyen D, Jordan PJ. An Integrative Literature Review of the Factors That Contribute to Professional Nurses and Midwives Making Sound Clinical Decisions. Int J Nurs Knowl 2015; 28:19-29. [DOI: 10.1111/2047-3095.12096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Wilma ten Ham
- Department of Nursing Science; Nelson Mandela Metropolitan University; Port Elizabeth South Africa
| | - Esmeralda J. Ricks
- Department of Nursing Science; Nelson Mandela Metropolitan University; Port Elizabeth South Africa
| | - Dalena van Rooyen
- School of Clinical Care Sciences; Faculty of Health Sciences; Nelson Mandela Metropolitan University; Port Elizabeth South Africa
| | - Portia J. Jordan
- Department of Nursing Science; Nelson Mandela Metropolitan University; Port Elizabeth South Africa
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Mirhaghi A, Kooshiar H, Esmaeili H, Ebrahimi M. Outcomes for emergency severity index triage implementation in the emergency department. J Clin Diagn Res 2015; 9:OC04-7. [PMID: 26023578 PMCID: PMC4437092 DOI: 10.7860/jcdr/2015/11791.5737] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/10/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hospital triage scale in emergency departments needs to be valid and reliable. Lack of sufficient data exists on triage scale rigor in emergency departments of Iran. This study aimed to determine the impact of the emergency severity index (ESI) triage scale in the emergency department. MATERIALS AND METHODS A single-center study was conducted. Proportion of triage categories allocated to high-risk patients admitted to high-acuity departments was examined in observational period in June 2012 and May 2013. True triage score was reported based on patients` paper- based scenario questionnaire. Interrater reliability was assessed using unweighted kappa. Concordance among experts, nurses and physicians was examined. The Chi-square test and Kappa statistics was used for statistical analysis. RESULTS Triage decisions regarding high-risk patients before and after implementation period are independent from each other (χ2= 22.254; df=1; p<0.05) and more high-risk patients were recognized after implementation of the ESI. Overall agreement and concordance were (79%) and (κ=0.54) among nurses; (71%) and (κ=0.45) among physicians, (85%) and (κ=0.81) among experts, respectively. Correct triage decisions among clinicians were increased after implementation of the ESI. CONCLUSION The ESI as valid and reliable tool improving desirable outcomes` in the emergency department has been recommended but it may not reveal optimal outcomes in developing countries comparing to what have been achieved in the developed countries. In addition, patient influx in ESI level II could create considerable controversy with clinicians.
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Affiliation(s)
- Amir Mirhaghi
- PhD Candidate, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Kooshiar
- Assistant Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaeili
- Associate Professor, Department of Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Ebrahimi
- Assistant Professor, Department of Emergency Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Smith A, Lollar J, Mendenhall J, Brown H, Johnson P, Roberts S. Use of Multiple Pedagogies to Promote Confidence in Triage Decision Making: A Pilot Study. J Emerg Nurs 2013; 39:660-6. [DOI: 10.1016/j.jen.2011.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/17/2011] [Accepted: 12/07/2011] [Indexed: 10/28/2022]
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Effectiveness of Using the Front Door Score to Enhance the Chest Pain Triage Accuracy of Emergency Nurse Triage Decisions. J Cardiovasc Nurs 2013; 28:E55-64. [DOI: 10.1097/jcn.0b013e318277c5ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Milner A, Kõlves K, Kõlves K, Gladman B, De Leo D. Treatment priority for suicide ideation and behaviours at an Australian emergency department. World J Psychiatry 2013; 3:34-40. [PMID: 24175184 PMCID: PMC3782185 DOI: 10.5498/wjp.v3.i2.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/08/2013] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the treatment priority given to self-harmers presenting to a hospital emergency department (ED) in Queensland, Australia, over the period 2005-2010.
METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication (SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1 (in need of immediate treatment) to 5 (assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to investigate which methods of non-fatal suicidal behaviour (NFSB) were prioritised as most urgent.
RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. “Cutters” were considered as the least “urgent” subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC.
CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.
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Reducing uncertainty in triaging mental health presentations: examining triage decision-making. Int Emerg Nurs 2013; 22:47-51. [PMID: 23669028 DOI: 10.1016/j.ienj.2013.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 01/18/2013] [Accepted: 01/22/2013] [Indexed: 11/22/2022]
Abstract
Little is known about how emergency department (ED) nurses make decisions and even less is known about triage nurses' decision-making. There is compelling motivation to better understand the processes by which triage nurses make decisions, particularly with complex patient populations such as those with frequently emotive mental health and illness issues. While accuracy and reliability of triage decisions generally have been improved through the introduction of standardised triage scales and instruments, other factors such as lack of knowledge or confidence related to mental health issues, past experiences that may elicit transference and countertransference, judgments about individuals based on their behavioural presentations may impact on decisions made at triage. In this paper, we review the current research regarding the effectiveness of triage tools particularly with mental health presentations, present a theoretical framework that may guide research in understanding how triage nurses approach decision-making, and apply that framework to thinking about research in mental health-related triage. Developing a better understanding of how triage nurses make decisions, particularly in situations where issues related to mental health and illness may raise the levels of uncertainty, is crucial to ensure that they have the skills and tools they need to provide the most effective, sensitive, and compassionate care possible.
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Engebretsen S, Røise O, Ribu L. Triage in Norwegian emergency departments. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:285-9. [PMID: 23381163 DOI: 10.4045/tidsskr.11.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND An increasing number of patients and stricter requirements for quality and efficiency in the management of emergency patients have spurred several Norwegian emergency departments (EDs) to introduce triage as one of several measures. This introduction has taken place without any accompanying research. We therefore wanted to investigate the use and organisation of triage, as well as the use of triage scales in the emergency departments. MATERIAL AND METHOD In the spring of 2010, a cross-sectional survey was undertaken among EDs with the aid of a questionnaire and telephone interviews. RESULTS Altogether 45 of a total of 56 Norwegian emergency hospitals (80%) participated. All our respondents reported that emergency patients underwent assessment for level of urgency. 34 (76%) reported to use triage scales, and 17 (50%) of these used self-composed scales. 21 (68%) of a total of 31 EDs that had goals for triage reported to evaluate these goals. 14 and 15 EDs respectively reported to have designated triage personnel and triage area. 24 EDs required internal triage training for nurses and assistant nurses. INTERPRETATION Our study reveals varying practices for use and organisation of triage in Norwegian EDs. This may be an effect of the absence of guidelines from the health authorities and reflect the insufficient priority which is given to ED work.
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Affiliation(s)
- Stine Engebretsen
- Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Norway.
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36
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Acosta AM, Duro CLM, Lima MADDS. Atividades do enfermeiro nos sistemas de triagem/classificação de risco nos serviços de urgência: revisão integrativa. Rev Gaucha Enferm 2012; 33:181-90. [DOI: 10.1590/s1983-14472012000400023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivou-se identificar e avaliar as evidências disponíveis na literatura sobre as atividades do enfermeiro na classificação de risco nos serviços de urgência. Realizou-se uma revisão integrativa, com busca nas bases de dados Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrievel System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO). Foram selecionados 22 artigos que atenderam aos critérios de inclusão. Os resultados evidenciaram que as principais atribuições deste profissional são a avaliação do estado de saúde do usuário e a tomada de decisão, processo que necessita de conhecimento clínico e de tempo de experiência. O enfermeiro tem a capacidade de organizar o fluxo dos usuários conforme a prioridade do atendimento e a demanda dos serviços, sendo um profissional de excelência na execução da triagem/classificação de risco nos serviços de urgência.
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Wolf L. An integrated, ethically driven environmental model of clinical decision making in emergency settings. Int J Nurs Knowl 2012; 24:49-53. [PMID: 23413935 DOI: 10.1111/j.2047-3095.2012.01229.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore the relationship between multiple variables within a model of critical thinking and moral reasoning. METHODS A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis. FINDINGS The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. CONCLUSIONS The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy. PRACTICE IMPLICATIONS A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making.
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Affiliation(s)
- Lisa Wolf
- University of Massachusetts, Amherst
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Forsman B, Forsgren S, Carlström ED. Nurses working with Manchester triage – The impact of experience on patient security. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.aenj.2012.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Smith A. Using a theory to understand triage decision making. Int Emerg Nurs 2012; 21:113-7. [PMID: 23615518 DOI: 10.1016/j.ienj.2012.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/05/2012] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
The purpose of this discussion is to present triage decision making research within the context of the Revised Cognitive Continuum Theory. Triage is an essential clinical skill in emergency nursing. Understanding the best way to facilitate this skill is vital when educating new nurses or providing continuing education to practicing nurses. Delineating research evidence within a theory allows clinical educators to understand practices that foster successful triage skills and permits the grounding of educational strategies within a theoretical framework.
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Affiliation(s)
- Anita Smith
- Maternal Child Nursing Department, University of South Alabama, College of Nursing, Mobile, AL, USA.
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40
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Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis. BMC Emerg Med 2011; 11:16. [PMID: 21982119 PMCID: PMC3199257 DOI: 10.1186/1471-227x-11-16] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 10/07/2011] [Indexed: 11/30/2022] Open
Abstract
Background Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency. Discussion In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights. Summary We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.
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Affiliation(s)
- Ramesh P Aacharya
- Department of General Practice & Emergency Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
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41
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Abstract
Triage decision making is an essential skill for nurses. Through initial assessment, a nurse must be able to prioritize patient care on the basis of appropriate decision making. The purpose of this article is to present pilot study data on the Triage Decision-Making Inventory, which measures the identification of critical thinking, cognitive characteristics, intuition, and experience when making triage decisions. Establishing reliability and validity of the instrument in a sample of nurses with diverse specialties allows staff development experts to use the inventory to tailor training for new graduates and practicing nurses.
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Wolf L. Does Your Staff Really “Get” Initial Patient Assessment? Assessing Competency in Triage Using Simulated Patient Encounters. J Emerg Nurs 2010; 36:370-4. [DOI: 10.1016/j.jen.2010.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Forsgren S, Forsman B, Carlström ED. Working with Manchester triage – Job satisfaction in nursing. Int Emerg Nurs 2009; 17:226-32. [DOI: 10.1016/j.ienj.2009.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2008] [Revised: 03/22/2009] [Accepted: 03/23/2009] [Indexed: 11/26/2022]
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44
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Wolf L. When Trauma Walks Into Triage. J Emerg Nurs 2009; 35:389-91. [DOI: 10.1016/j.jen.2009.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Genewein U, Jakob M, Bingisser R, Burla S, Heberer M. [Organization of clinical emergency units. Mission and environmental factors determine the organizational concept]. Chirurg 2008; 80:130-7. [PMID: 18972092 DOI: 10.1007/s00104-008-1639-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Mission and organization of emergency units were analysed to understand the underlying principles and concepts. METHODS The recent literature (2000-2007) on organizational structures and functional concepts of clinical emergency units was reviewed. An organizational portfolio based on the criteria specialization (presence of medical specialists on the emergency unit) and integration (integration of the emergency unit into the hospital structure) was established. The resulting organizational archetypes were comparatively assessed based on established efficiency criteria (efficiency of resource utilization, process efficiency, market efficiency). RESULTS Clinical emergency units differ with regard to autonomy (within the hospital structure), range of services and service depth (horizontal and vertical integration). The "specialization"-"integration"-portfolio enabled the definition of typical organizational patterns (so-called archetypes): profit centres primarily driven by economic objectives, service centres operating on the basis of agreements with the hospital board, functional clinical units integrated into medical specialty units (e.g., surgery, gynaecology) and modular organizations characterized by small emergency teams that would call specialists immediately after triage and initial diagnostic. CONCLUSIONS There is no "one fits all" concept for the organization of clinical emergency units. Instead, a number of well characterized organizational concepts are available enabling a rational choice based on a hospital's mission and demand.
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Affiliation(s)
- U Genewein
- Forschungsgruppe Spitalmanagement, Institut für Chirurgische Forschung und Spitalmanagement, Universitätsspital, Basel, Switzerland
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