1
|
Noel F, Lefèvre A, Galimard JE, Pognonec C, Kassasseya C, Yefsah S, Yordanov Y, Thiebaud PC. Evaluation of use and identification of predictive factors for nonuse of peripheral venous catheters in the emergency department. Intern Emerg Med 2024; 19:2259-2267. [PMID: 38630346 DOI: 10.1007/s11739-024-03603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/02/2024] [Indexed: 11/22/2024]
Abstract
The placement of peripheral venous catheters (PVC) is a frequent procedure in the emergency department (ED), which exposes patients to complications (hematoma, fluid leakage, phlebitis, edema, infection), increases hemolysis of blood samples, is time-consuming and costly. The main aim of this study is to analyze the rate of PVC nonuse in the ED and to identify predictive factors of their nonuse. This prospective single-center observational study was conducted in the ED of the Saint-Antoine Hospital in Paris, France between February and March 2022. Adult patients receiving a PVC were included. In addition to demographic and medical data, the reason for PVC prescription and the prescribing physician's expectation of PVC use were collected. A total of 304 patients were included, with a median age of 61.5 years (IQR: 43-79 years), of whom 152 (50%) were men. PVC were primarily prescribed for intravenous medication administration. Seventy-two (23.7%) PVC were not used. In multivariable analysis, the predictive factors of nonuse were the prescribing physician's expectation of nonuse [OR 6.35, CI 95% (2.64-15.29), for "no" and "not sure" vs. "yes" responses] and the reason for prescribing "just in case" [OR 3.54, CI 95% (1.37-9.17)]. PVC were not used in 23.7% of cases. Predictors of nonuse were the prescribing physician's expectation of nonuse and the reason for prescribing "just in case". A PVC should probably not be prescribed if the prescribing physician thinks it will not be used or prescribes it "just in case".
Collapse
Affiliation(s)
- Florent Noel
- Service d'Accueil Des Urgences, Hôpital Saint Antoine, AP-HP.Sorbonne Université, 184, Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Aurélie Lefèvre
- Service d'Accueil Des Urgences, Hôpital Saint Antoine, AP-HP.Sorbonne Université, 184, Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | | | - Célina Pognonec
- Service d'Accueil Des Urgences, Hôpital Cochin, AP-HP.Université de Paris Cité, Paris, France
| | - Christian Kassasseya
- Service d'Accueil Des Urgences, Hôpital Henri Mondor, AP-HP.Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Sofiane Yefsah
- Service d'Accueil Des Urgences, Hôpital Tenon, AP-HP.Sorbonne Université, Paris, France
| | - Youri Yordanov
- Service d'Accueil Des Urgences, Hôpital Saint Antoine, AP-HP.Sorbonne Université, 184, Rue du Faubourg Saint-Antoine, 75012, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Pierre-Clément Thiebaud
- Service d'Accueil Des Urgences, Hôpital Saint Antoine, AP-HP.Sorbonne Université, 184, Rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France.
| |
Collapse
|
2
|
Pilleron B, Douillet D, Furon Y, Haubertin C, Parot-Schinkel E, Vielle B, Roy PM, Poiroux L. Nurses' moral judgements during emergency department triage - A prospective mixed multicenter study. Int Emerg Nurs 2024; 75:101479. [PMID: 38936277 DOI: 10.1016/j.ienj.2024.101479] [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: 11/20/2023] [Revised: 04/27/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION In EDs, triage ensures that patients whose condition requires immediate care are prioritized while reducing overcrowding. Previous studies have described the manifestation of caregivers' moral judgements of patients in EDs. The equal treatment of patients in clinical practice presents a major issue. Studying the impact of prejudice on clinical practice in the ED setting provides an opportunity to rethink clinical tools, organizations and future training needs. Our study sought to describe the moral judgements expressed by triage nurses during admission interviews in emergency departments and to assess their impact on patient management. METHODS An exploratory sequential mixed-method study was performed. The study was conducted between January 1, 2018, and February 18, 2018, in the EDs of three French hospitals. Five hundred and three patients and 79 triage nurses participated in the study. Audio recordings, observations and written handover reports made by nurses during admission triage interviews were analyzed with a view to discerning whether moral judgements were expressed in them. We studied the impact of moral judgements on patient management in the emergency department. RESULTS Abstract Moral judgements were made in 70% of the triage situations studied (n=351/503). They could be classified in seven categories. Patients were more likely to be subjected to moral judgements if they were over 75 years old, visibly disabled or if they had visible signs of alcohol intoxication. Being subjected to moral judgement was associated with differential treatment, including assignment of a triage score that differed from the theoretical triage score. CONCLUSION More than two thirds of patients admitted to EDs were triaged using moral criteria. Patients who were morally judged at the admission interview were more likely to be treated differently.
Collapse
Affiliation(s)
| | - Delphine Douillet
- Emergency Department, Angers University Hospital, Angers, France; MITOVASC, Equipe CarMe, INSERM 1083, CNRS 6015, SFR ICAT, UNIV Angers, Angers, France; F-CRIN INNOVTE, Saint-Etienne, France
| | - Yoakim Furon
- Research Department, Angers University Hospital, Angers, France
| | - Carole Haubertin
- Emergency Department, Angers University Hospital, Angers, France
| | - Elsa Parot-Schinkel
- Biostatistics and Methodology Department, Angers University Hospital, Angers, France
| | - Bruno Vielle
- Research Department, Angers University Hospital, Angers, France
| | - Pierre-Marie Roy
- Emergency Department, Angers University Hospital, Angers, France; MITOVASC, Equipe CarMe, INSERM 1083, CNRS 6015, SFR ICAT, UNIV Angers, Angers, France; F-CRIN INNOVTE, Saint-Etienne, France; Research Department, Angers University Hospital, Angers, France
| | - Laurent Poiroux
- Research Department, Angers University Hospital, Angers, France; Biostatistics and Methodology Department, Angers University Hospital, Angers, France; Équipe d'épidémiologie en santé au travail et ergonomie (ESTER) - Irset UMR_S 1085, University of Angers, France
| |
Collapse
|
3
|
Poret J, Fauviaux E, Jany B, Bourges JL, Tran THC. [Creation and evaluation of a triage survey for ophthalmology emergencies]. J Fr Ophtalmol 2024; 47:104017. [PMID: 37945430 DOI: 10.1016/j.jfo.2023.09.016] [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: 07/03/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE The demand for eye care is growing continuously. We created a triage survey system, based on categories of severity, to optimize first line patient care in an ophthalmology emergency department. METHODS This cross-sectional study was carried out from July 7th, 2021 to October 10th, 2021. During this period, a survey was taken by patients upon arrival to the emergency department. Patients completed the survey by ticking boxes that best fitted their situation. The survey classified patients into three categories of severity: GREEN, ORANGE and RED. A chart review was performed to record the final diagnoses. The severity of each diagnosis was rated according to the Base Score. This score was then compared to the level of severity as determined by our survey to calculate the agreement between the two methods. RESULTS We collected 767 survey forms, with an 80% response rate. We noted 78 different diagnoses. We scored 564 patients as GREEN, 107 as ORANGE and 96 as RED. The sensitivity rates for the green, orange and red categories were 90%, 70% and 96% respectively. The specificity rates were 90% for the green category, 95% for orange and 94% for red, with good agreement (kappa coefficient=0.70). CONCLUSION Our results suggest that a self-administered survey could be useful as a triage tool for common ocular emergencies. This survey could be performed better if complete by the patients with the assistance of emergency staff. Potentially helpful for high flow structures such as university-based hospitals, this triage survey might also help in comprehensive clinics or emergency departments.
Collapse
Affiliation(s)
- J Poret
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France.
| | - E Fauviaux
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - B Jany
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| | - J L Bourges
- Ophtalmopôle de Paris, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Cité, Paris, France
| | - T H C Tran
- Service d'ophtalmologie, centre hospitalier universitaire d'Amiens, 1, rue du Professeur-Christian-Cabrol, 8000 Amiens, France
| |
Collapse
|
4
|
Balen F, Routoulp S, Charpentier S, Azema O, Houze-Cerfon CH, Dubucs X, Lauque D. Impact of emergency department length of stay on in-hospital mortality: a retrospective cohort study. Eur J Emerg Med 2024; 31:39-45. [PMID: 37788143 DOI: 10.1097/mej.0000000000001079] [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: 10/05/2023]
Abstract
BACKGROUND AND IMPORTANCE Emergency Department (ED) workload may lead to ED crowding and increased ED length of stay (LOS). ED crowding has been shown to be associated with adverse events and increasing mortality. We hypothesised that ED-LOS is associated with mortality. OBJECTIVE To study the relationship between ED-LOS and in-hospital mortality. DESIGN Observational retrospective cohort study. SETTINGS AND PARTICIPANTS From 1 January 2015 to 30 September 2018, all visits by patients aged 15 or older to one of the two ED at Toulouse University Hospital were screened. Patients admitted to the hospital after ED visits were included. Visits followed by ED discharge, in-ED death or transfer to ICU or another hospital were not included. OUTCOME MEASURE AND ANALYSIS The primary outcome was 30-day in-hospital mortality. ED-LOS was defined as time from ED registration to inpatient admission. ED-LOS was categorised according to quartiles [<303 min (Q1), between 303 and 433 minutes (Q2), between 434 and 612 minutes (Q3) and >612 min (Q4)]. A multivariable logistic regression tested the association between ED-LOS and in-hospital mortality. MAIN RESULTS A total of 49 913 patients were admitted to our hospital after ED visits and included in the study. ED-LOS was not independently associated with in-hospital mortality. Compared to ED-LOS < 303 min (Q1, reference), odd-ratios (OR) [95% CI] of in-hospital mortality for Q2, Q3, and Q4 were respectively 0.872 [0.747-1.017], 0.906 [0.777-1.056], and 1.137 [0.985-1.312]. Factors associated to in-hospital mortality were: aged over 75 years (OR [95% CI] = 4.3 [3.8-4.9]), Charlson Comorbidity Index score > 1 (OR [95% CI] = 1.3 [1.1-1.5], and 2.2 [1.9-2.5] for scores 2 and ≥ 3 respectively), high acuity at triage (OR [95% CI] = 3.9 [3.5-4.4]), ED visit at Hospital 1 (OR [95% CI] = 1.6 [1.4-1.7]), and illness diagnosis compared to trauma (OR [95% CI] = 2.1 [1.7-2.6]). Night-time arrival was associated with decreased in-hospital mortality (OR [95% CI] = 0.852 [0.767-0.947]). CONCLUSION In this retrospective cohort study, there was no independent association between ED-LOS before admission to general non-ICU wards and in-patient mortality.
Collapse
Affiliation(s)
- Frederic Balen
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
| | | | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
- Toulouse III - Paul Sabatier University
| | - Olivier Azema
- Département D'Information Médicale (DIM), Toulouse University Hospital, Toulouse, France
| | | | - Xavier Dubucs
- Emergency Department, Toulouse University Hospital
- CERPOP - EQUITY, INSERM
- Toulouse III - Paul Sabatier University
| | - Dominique Lauque
- Emergency Department, Toulouse University Hospital
- Toulouse III - Paul Sabatier University
| |
Collapse
|
5
|
Navion A, Segretin P, Bailhache M. Smartphone App PACOM to Provide Advice Regarding Self-Triage for the Acute Primary Care Needs of Children: Accuracy of Algorithms. Pediatr Emerg Care 2024; 40:27-32. [PMID: 37820384 DOI: 10.1097/pec.0000000000003068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND We developed a phone app, PACOM (Parents Application Conseils et Orientation Médicale), to provide medical advice to caregivers based on several algorithms and a series of binary questions related to children's symptoms. We compared the recommendations of the PACOM algorithms and clinicians for children visiting the emergency department (ED). METHODS Between January and February 2022, we prospectively recruited French-speaking parents of children without any chronic disease who presented to the pediatric ED with any complaint except for mental health problems or trauma. Isolated head trauma was included. They completed questionnaires and the various PACOM algorithms. The first algorithm, called "Quick Look," was developed to identify children with life-threatening emergencies. The standard reference was the advice of the ED clinicians who were blinded to the parental responses to the PACOM algorithm questions. The recommendations included "call urgent medical support," "visit the ED," "visit your general practitioner within 24 hours," and "visit your general practitioner in the next days." RESULTS The study included 269 parents. The response rate was 75%. The median age of the children was 3 years with interquartile range: 1 to 7 years. In total, 268 children completed the "Quick Look," 141 "fever," 83 "abdominal pain," 72 "cough," 70 "vomiting," 130 questionnaires relative to other proposed symptoms, and 70 "other symptom" questionnaires. The PACOM recommendations were "call urgent medical assistant" for 98 children, "ED visit" for 131, "visit general practitioner within 24 hours" for 13, and "visit general practitioner during the next days" for 24. The sensitivity and specificity of the PACOM recommendation to "call urgent medical support or visit the ED" were 98.1% (95% confidence interval, 95.5-100.00) and 22.1% (95% confidence interval, 15.3-28.8), respectively. CONCLUSIONS The PACOM algorithms has high sensitivity but low specificity for reducing ED visits and calls for urgent medical support.
Collapse
Affiliation(s)
- Anouk Navion
- From the CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Pierre Segretin
- From the CHU de Bordeaux, Pole de pediatrie, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | | |
Collapse
|
6
|
Ghazali DA, Bouzid D, Frachon A, Ait-Abdesselam S, Kenway P, Choquet C, Casalino E. Pain Self-Management with Inhaled Methoxyflurane by Emergency Department Trauma Patients: A Prospective, Interventional, Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6107. [PMID: 37372694 DOI: 10.3390/ijerph20126107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to overcrowding in many emergency departments (EDs). The present single-center, prospective, interventional study (conducted at Bichat University Medical Center (Paris, France)) was designed to assess the impact of self-administered, inhaled, low-dose methoxyflurane on trauma pain in a pre-ED fast-track zone dedicated to the management of lower-acuity non-COVID-19 patients. In the first phase of the study, the control group consisted of patients with mild-to-moderate trauma pain, for whom the triage nurse initiated pain management (based on the World Health Organization (WHO)'s analgesic ladder). In the second phase, the intervention group consisted of similar patients who self-administered methoxyflurane as an adjuvant to the standard analgesic ladder. The primary endpoint was the numerical pain rating scale (NPRS) score (from 0 to 10) recorded at different time points during the patient's care (T0: arrival in the ED, T1: exit from the triage box, T2: in the radiology department, T3: clinical examination, and T4: discharge from the ED). The level of agreement between the NPRS and the WHO analgesic ladder was assessed by the calculation of Cohen's kappa. Pairwise comparisons of continuous variables were performed with Student's t-test or a non-parametric Mann-Whitney U test. Changes over time in the NPRS were analyzed in an analysis of variance (with Scheffe's post hoc test if a pairwise comparison was significant) or a non-parametric Kruskal-Wallis H test. In all, 268 and 252 patients were included in the control and intervention groups, respectively. The two groups had similar characteristics. The level of agreement between the NPRS score and the analgesic ladder was high in both the control and intervention groups (Cohen's kappa: 0.74 and 0.70, respectively). The NPRS score decreased significantly between T0 and T4 in both groups (p < 0.001), but the decrease between T2 and T4 was significantly greater in the intervention group (p < 0.001). The proportion of patients still in pain on discharge was significantly lower in the intervention group than in the control group (p = 0.001). In conclusion, a combination of self-administered methoxyflurane and the WHO analgesic ladder improves pain management in the ED.
Collapse
Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department and Emergency Medical Services, Amiens University Medical Center, 1 Rond-Point du Professeur Christian Cabrol, 80000 Amiens, France
- DREAMS (Department of Research in Emergency Medicine and Simulation) Research Unit, Amiens University Medical Center and Jules Verne University of Picardie, 80000 Amiens, France
- IAME "Infection, Antimicrobials, Modelling, Evolution" Research Unit, INSERM UMR1137, University of Paris Cité, 75018 Paris, France
| | - Donia Bouzid
- IAME "Infection, Antimicrobials, Modelling, Evolution" Research Unit, INSERM UMR1137, University of Paris Cité, 75018 Paris, France
- Emergency Department, Bichat University Medical Center, 75018 Paris, France
| | - Alix Frachon
- Emergency Department, Bichat University Medical Center, 75018 Paris, France
| | | | - Philippe Kenway
- Emergency Department, Bichat University Medical Center, 75018 Paris, France
| | - Christophe Choquet
- Emergency Department, Bichat University Medical Center, 75018 Paris, France
| | - Enrique Casalino
- IAME "Infection, Antimicrobials, Modelling, Evolution" Research Unit, INSERM UMR1137, University of Paris Cité, 75018 Paris, France
- Emergency Department, Bichat University Medical Center, 75018 Paris, France
| |
Collapse
|
7
|
Pognonec C, Dirhoussi Z, Cury N, Moreau M, Billard C, Yordanov Y, Thiebaud PC. External validation of Glasgow-Blatchford, modified Glasgow-Blatchford and CANUKA scores to identify low-risk patients with upper gastrointestinal bleeding in emergency departments: a retrospective cohort study. Emerg Med J 2023; 40:451-457. [PMID: 37185303 DOI: 10.1136/emermed-2022-213052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a medical emergency with an approximate mortality of 10%, which results in a high hospitalisation rate. The Glasgow-Blatchford score (GBS) is recommended to identify low-risk patients who can be discharged from the emergency department (ED). A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. The aim of this study was to assess whether the use of GBS, mGBS or CANUKA score could identify patients at low risk of death or need for intervention. METHODS A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018. Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data. Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days. In-hospital mortality was also collected. Sensitivity, specificity and predictive values were measured for the score thresholds of interest. RESULTS A total of 386 patients were included. Median age was 60 years (38-78), 65.3% (n=252) were male and 60% (n=233) were hospitalised. A GBS≤1, mGBS=0 and CANUKA≤2 categorised 24.9%, 18.2% and 18.9% of patients as low risk, respectively. There was a need for intervention in 2.2%, 4.6% and 0% of those patients categorised as low risk by GBS, mGBS and CANUKA, respectively. No deaths occurred in the patients identified as low risk, regardless of the score used. All scores had a high sensitivity and negative predictive value. CONCLUSIONS In patients with UGIB, the use of a GBS≤1 or CANUKA score ≤2 appears to be safe for identifying patients at low risk of death or need for intervention.
Collapse
Affiliation(s)
- Célina Pognonec
- Hôpital Cochin, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Université Paris Cité, Paris, France
| | - Zidane Dirhoussi
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Nicolas Cury
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Marie Moreau
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Charlotte Billard
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| | - Youri Yordanov
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Sorbonne Universite, Paris, France
| | - Pierre-Clément Thiebaud
- Hôpital Saint-Antoine, Service d'Accueil des Urgences, Assistance Publique - Hôpitaux de Paris, AP-HP.Sorbonne Université, Paris, France
| |
Collapse
|
8
|
Savioli G, Ceresa IF, Bressan MA, Piccini GB, Varesi A, Novelli V, Muzzi A, Cutti S, Ricevuti G, Esposito C, Voza A, Desai A, Longhitano Y, Saviano A, Piccioni A, Piccolella F, Bellou A, Zanza C, Oddone E. Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding-The CREONTE (Crowding and RE-Organization National TriagE) Study Group. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040781. [PMID: 37109739 PMCID: PMC10143416 DOI: 10.3390/medicina59040781] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care.
Collapse
Affiliation(s)
- Gabriele Savioli
- Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Maria Antonietta Bressan
- Department of Emergency Medicine and Surgery, IRCCS Fondanzione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Angelica Varesi
- Faculty of Medicine, University of Pavia, 27100 Pavia, Italy
| | - Viola Novelli
- Health Department, University of Pavia, 27100 Pavia, Italy
| | - Alba Muzzi
- Health Department, University of Pavia, 27100 Pavia, Italy
| | - Sara Cutti
- Health Department, University of Pavia, 27100 Pavia, Italy
| | | | - Ciro Esposito
- Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy
| | - Antonio Voza
- Emergency Department, Humanitas University, Via Rita Levi Montalcini 4, 20089 Milan, Italy
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Angela Saviano
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Fabio Piccolella
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Abdel Bellou
- Institute of Sciences in Emergency Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Christian Zanza
- Department of Anesthesiology and Intensive Care Medicine-AON Antonio, Biagio e Cesare Arrigo, 15100 Alessandria, Italy
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| |
Collapse
|
9
|
Aubrion A, Clanet R, Jourdan JP, Creveuil C, Roupie E, Macrez R. FRENCH versus ESI: comparison between two nurse triage emergency scales with referent scenarios. BMC Emerg Med 2022; 22:201. [PMID: 36503501 PMCID: PMC9743579 DOI: 10.1186/s12873-022-00752-z] [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] [Received: 01/16/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Acute triage is needed to prioritize care and achieve optimal resource allocation in busy emergency departments. The main objective is to compare the FRench Emergency Nurse Classification in Hospital scale (FRENCH) to the American scale Emergency Severity Index (ESI). Secondary objectives are to compare for each scale the over and under-triage, the triage matching to the gold standard and the inter-individual sorting reproducibility between the nurses. METHODS This is a prospective observational study conducting among the nursing staffs and nursing students, selected from Caen University College Hospital and Lisieux Hospital Center emergency departments between two months. Each group individually rank 60 referent clinical cases composed by scales designers. An assessment of scale practicality is collected after for each tool. The collected parameters are analyzed by a Cohen kappa concordance test (κ). RESULTS With 8151 triage results of gold standard scenarios sorting in two scales by the same nurses, the FRENCH scale seems to give better triage results than the US ESI scale (nurse: FRENCH 60% and ESI 53%, p = 0.003 ; nursing students: FRENCH 49% and ESI 42%, p < 0.001). In the two groups ESI has also a big tendency to under-sort (p = 0.01), particularly for the most severe patients (p < 0.01). The interobserver sorting concordance for any experience gives good results for the FRENCH and the ESI without any difference (nurses : FRENCH KPQ=0.72 ESI KPQ=0.78; p = 0.32 ; students KPQ=0.44 KPQ=0.55; p = 0.22). CONCLUSION The ESI and FRENCH scales comparison on 8151 sorting results shows direct validity in favor of FRENCH one and similar interobserver agreement for both scales.
Collapse
Affiliation(s)
- Antoine Aubrion
- grid.411149.80000 0004 0472 0160Emergency medical service (SAMU 14), Caen University Hospital, Caen, France ,Emergency department, Lisieux Hospital, Lisieux, France ,grid.411149.80000 0004 0472 0160Department of emergency medicine, Caen-Normandie Hospital (CHU), Caen, France
| | - Romain Clanet
- grid.411149.80000 0004 0472 0160Emergency medical service (SAMU 14), Caen University Hospital, Caen, France ,Emergency department, Bayeux Hospital, Bayeux, France
| | - JP Jourdan
- Pharmacy department, Public hospital, Vire, France
| | - Christian Creveuil
- grid.411149.80000 0004 0472 0160Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | - E Roupie
- grid.411149.80000 0004 0472 0160Emergency medical service (SAMU 14), Caen University Hospital, Caen, France ,grid.412043.00000 0001 2186 4076Physiopathology and Imaging of Neurological Disorders, Normandie Univ, UNICAEN, INSERM, UMR-S U1237, Institut Blood and Brain @ CaenNormandie, GIP Cyceron, Boulevard Becquerel, 14074, Caen, France
| | - Richard Macrez
- grid.411149.80000 0004 0472 0160Emergency medical service (SAMU 14), Caen University Hospital, Caen, France ,grid.412043.00000 0001 2186 4076Physiopathology and Imaging of Neurological Disorders, Normandie Univ, UNICAEN, INSERM, UMR-S U1237, Institut Blood and Brain @ CaenNormandie, GIP Cyceron, Boulevard Becquerel, 14074, Caen, France ,grid.412043.00000 0001 2186 4076Normandie Univ, Unicaen, Cermn, 14000 Caen, France
| |
Collapse
|
10
|
Flamant L, Giordano Orsini G, Ramont L, Gornet M, De Ruffi S, Leroux P, Kanagaratnam L, Gennai S. Association between admission biomarkers and clinical outcome in older adults diagnosed with an infection in the emergency department. Acta Clin Belg 2022:1-6. [DOI: 10.1080/17843286.2022.2146929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucas Flamant
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | | | - Laurent Ramont
- Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, SFR CAP-Santé, Reims, France
| | - Marion Gornet
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Sebastien De Ruffi
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Pierre Leroux
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Lukshe Kanagaratnam
- Clinical Research Unit, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, INSERM, P3Cell, U 1250, Reims, France
| |
Collapse
|
11
|
Frequency, Characteristics, and Predictive Factors of Adverse Drug Events in an Adult Emergency Department according to Age: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11195731. [PMID: 36233599 PMCID: PMC9572040 DOI: 10.3390/jcm11195731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.
Collapse
|
12
|
Arnaud E, Elbattah M, Ammirati C, Dequen G, Ghazali DA. Use of Artificial Intelligence to Manage Patient Flow in Emergency Department during the COVID-19 Pandemic: A Prospective, Single-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9667. [PMID: 35955022 PMCID: PMC9368666 DOI: 10.3390/ijerph19159667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, calculation of the number of emergency department (ED) beds required for patients with vs. without suspected COVID-19 represented a real public health problem. In France, Amiens Picardy University Hospital (APUH) developed an Artificial Intelligence (AI) project called "Prediction of the Patient Pathway in the Emergency Department" (3P-U) to predict patient outcomes. MATERIALS Using the 3P-U model, we performed a prospective, single-center study of patients attending APUH's ED in 2020 and 2021. The objective was to determine the minimum and maximum numbers of beds required in real-time, according to the 3P-U model. Results A total of 105,457 patients were included. The area under the receiver operating characteristic curve (AUROC) for the 3P-U was 0.82 for all of the patients and 0.90 for the unambiguous cases. Specifically, 38,353 (36.4%) patients were flagged as "likely to be discharged", 18,815 (17.8%) were flagged as "likely to be admitted", and 48,297 (45.8%) patients could not be flagged. Based on the predicted minimum number of beds (for unambiguous cases only) and the maximum number of beds (all patients), the hospital management coordinated the conversion of wards into dedicated COVID-19 units. DISCUSSION AND CONCLUSIONS The 3P-U model's AUROC is in the middle of range reported in the literature for similar classifiers. By considering the range of required bed numbers, the waste of resources (e.g., time and beds) could be reduced. The study concludes that the application of AI could help considerably improve the management of hospital resources during global pandemics, such as COVID-19.
Collapse
Affiliation(s)
- Emilien Arnaud
- Department of Emergency Medicine, Amiens Picardy University Hospital, 80000 Amiens, France
- Laboratoire Modélisation, Information, Systèmes (MIS), University of Picardie Jules Verne, 80080 Amiens, France
| | - Mahmoud Elbattah
- Laboratoire Modélisation, Information, Systèmes (MIS), University of Picardie Jules Verne, 80080 Amiens, France
- Faculty of Environment and Technology, University of the West of England, Bristol BS16 1QY, UK
| | - Christine Ammirati
- Department of Emergency Medicine, Amiens Picardy University Hospital, 80000 Amiens, France
- Amiens Picardy University Hospital—SimuSanté, 80000 Amiens, France
| | - Gilles Dequen
- Laboratoire Modélisation, Information, Systèmes (MIS), University of Picardie Jules Verne, 80080 Amiens, France
| | - Daniel Aiham Ghazali
- Laboratoire Modélisation, Information, Systèmes (MIS), University of Picardie Jules Verne, 80080 Amiens, France
- INSERM UMR1137, Infection, Antimicrobials, Modelling, Evolution, University of Paris-Diderot, 75018 Paris, France
| |
Collapse
|
13
|
Casarin C, Pirot AS, Gregoire C, Van Der Haert L, Vanden Berghe P, Castanares-Zapatero D, Dechamps M. Improving the performance of a triage scale for chest pain patients admitted to emergency departments: combining cardiovascular risk factors and electrocardiogram. BMC Emerg Med 2022; 22:118. [PMID: 35788195 PMCID: PMC9251936 DOI: 10.1186/s12873-022-00680-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/24/2022] [Indexed: 11/28/2022] Open
Abstract
Background The triage of patients presenting with chest pain on admission to the emergency department uses scales based on patient clinical presentation or an electrocardiogram (ECG). These scales have different sensitivity and specificity. Although a good sensitivity allows for the prompt identification of high-risk patients, specificity prevent ED overcrowding. Moreover, ECG at triage avoids missing ST elevation myocardial infarction, which requires urgent revascularization. Our study therefore aimed to investigate whether a scale combining ECG and cardiovascular risk factors (CVRF) improves the diagnostic performance of ED chest pain triage scale. Methods and results In this prospective single-center observational study involving 505 patients, the standard ECG-based FRENCH scale was compared to a scale combining the ECG-based FRENCH scale and the patients CVRF. The new scale was called the “modified” FRENCH. The accuracy of patient CVRF collection was evaluated by comparing the results of triage nurses and ED physicians. Compared with the standard FRENCH scale, the modified FRENCH scale had an increased sensitivity (61% versus 75%) but a decrease in specificity (76% versus 64%) resulting in a similar diagnostic performance. Using CVRF collected by the ED physicians, the modified FRENCH scale had a sensitivity of 87% and a specificity of 56% with a significant improvement in his diagnostic performance compared with standard FRENCH scales. This improvement can be explained by an accurate collection of the CVRF by physicians compared with nurses, as suggested by the weak to moderate correlation between their respective data collection. Conclusion In conclusion, combining ECG and accurately collected cardiovascular risks factor improves the diagnostic performance of the ECG based chest pain triage in the ED. Trial registration Trial registration number: NCT03913767.
Collapse
Affiliation(s)
- Chiara Casarin
- Emergency Department, Saint-Luc University Hospital, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anne-Sophie Pirot
- Emergency Department, Saint-Luc University Hospital, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Charles Gregoire
- Emergency Department, Saint-Luc University Hospital, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Institute of Neuroscience (IoNS), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Laurence Van Der Haert
- Cardiovascular Intensive Care Unit, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium
| | - Patrick Vanden Berghe
- Emergency Department, Saint-Luc University Hospital, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Diego Castanares-Zapatero
- Intensive Care Unit, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium.,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Melanie Dechamps
- Cardiovascular Intensive Care Unit, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium. .,Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), UCLouvain, Brussels, Belgium.
| |
Collapse
|
14
|
Reliability and Validity of a New Computer-Based Triage Decision Support Tool: ANKUTRIAGE. Disaster Med Public Health Prep 2022; 17:e162. [PMID: 35765149 DOI: 10.1017/dmp.2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively. METHODS ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated. RESULTS The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased (P < 0.05). CONCLUSIONS ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.
Collapse
|
15
|
Impact of Fast SARS-CoV-2 Molecular Point-Of-Care Testing on Patients' Length of Stay in an Emergency Department. Microbiol Spectr 2022; 10:e0063622. [PMID: 35730967 PMCID: PMC9431206 DOI: 10.1128/spectrum.00636-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The ID NOW COVID-19 system (IDNOW) is a point-of-care test (POCT) providing results within 15 min. We evaluated the impact of IDNOW use on patient length of stay (LOS) in an emergency department (ED). In the ED of Saint-Louis Hospital, Paris, France, adult patients requiring a rapid diagnosis of SARS-CoV-2 were tested with Cepheid Xpert Xpress SARS-CoV-2 or FilmArray respiratory panel RP2 in the virology laboratory between 18 October and 3 November 2020 (period 1) and with IDNOW between 4 November and 30 November 2020 (period 2). A total of 676 patients participated in the study, 337 during period 1 and 339 during period 2. The median LOS in ED was significantly higher in period 1 than in period 2 (276 versus 208 min, P < 0.0001). More patients spent less than 4 h in the ED in period 2 (61.3%) than in period 1 (38.3%) (P < 0.0001). By univariate analysis, factors associated with ED LOS were hypertension, anosmia/ageusia, number of patients per day, and ID NOW implementation in period 2. By multivariate analysis, the period of testing remained significantly associated with ED LOS. Rapid molecular SARS-CoV-2 POCT was associated with a reduced LOS for patients admitted to an ED. IMPORTANCE During COVID-19 pandemic upsurges, emergency departments had to deal with a massive flow of incoming patients. The need for COVID-19 infection status determination before medical ward admission worsened ED overcrowding. The development of molecular point-of-care testing gave new opportunities for getting faster results of SARS-CoV-2 genome detection 24 h a day. In our study, we show, with a multivariate analysis, that the use of the POCT COVID-19 IDNOW reduced the ED length of stay by 1 h. The rate of patients who waited less than 4 h in the ED increased significantly. Our study highlights the benefit of COVID-19 molecular POCT for preventing ED overcrowding and facilitating bed allocation and SARS-CoV-2-infected patient isolation.
Collapse
|
16
|
Laureau M, Vuillot O, Gourhant V, Perier D, Pinzani V, Lohan L, Faucanie M, Macioce V, Marin G, Giraud I, Jalabert A, Villiet M, Castet-Nicolas A, Sebbane M, Breuker C. Adverse Drug Events Detected by Clinical Pharmacists in an Emergency Department: A Prospective Monocentric Observational Study. J Patient Saf 2021; 17:e1040-e1049. [PMID: 32175969 DOI: 10.1097/pts.0000000000000679] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adverse drug events (ADEs) are a major public health issue in hospitals. They are difficult to detect because of incomplete or unavailable medication history. In this study, we aimed to assess the rate and characteristics of ADEs identified by pharmacists in an emergency department (ED) to identify factors associated with ADEs. METHODS In this prospective observational study, we included consecutive adult patients presenting to the ED of a French 2600-bed tertiary care university hospital from November 2011 to April 2015. Clinical pharmacists conducted structured interviews and collected the medication history to detect ADEs (i.e., injuries resulting directly or indirectly from adverse drug reactions and noncompliance to medication prescriptions). Unsure ADE cases were reviewed by an expert committee. Relations between patient characteristics, type of ED visit, and ADE risk were analyzed using logistic regression. RESULTS Among the 8275 included patients, 1299 (15.7%) presented to the ED with an ADE. The major ADE symptoms were bleeding, endocrine problems, and neurologic disorders. Moreover, ADEs led to the ED visit, hospitalization, and death in 87%, 49.3%, and 2.2% of cases, respectively. Adverse drug event risk was independently associated with male sex, ED visit for neurological symptoms, visit to the ED critical care unit, or ED short stay hospitalization unit, use of blood, anti-infective, antineoplastic, and immunomodulating drugs. CONCLUSIONS This study improves the knowledge about ADE characteristics and on the patients at risk of ADE. This could help ED teams to better identify and manage ADEs and to improve treatment quality and safety.
Collapse
|
17
|
Lohan L, Marin G, Faucanie M, Laureau M, Macioce V, Perier D, Pinzani V, Giraud I, Castet-Nicolas A, Jalabert A, Villiet M, Sebbane M, Breuker C. Impact of medication characteristics and adverse drug events on hospital admission after an emergency department visit: Prospective cohort study. Int J Clin Pract 2021; 75:e14224. [PMID: 33866662 DOI: 10.1111/ijcp.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/12/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Emergency department (ED) overcrowding is a problem for the delivery of adequate and timely emergency care. To improve patient flow and the admission process, the quick prediction of a patient's need for admission is crucial. We aimed to investigate the variables associated with hospitalisation after an ED visit, with a particular focus on the variables related to medication. METHODS This prospective study was conducted from 2011 to 2018 in subacute medical ED of a French University Hospital. Specialised EDs (paediatric, gynaecologic, head and neck and psychiatric) and the outpatient unit of the ED were not included. Participation in this study was proposed to all adult patients who underwent a medication history interview with a pharmacist. Pharmacists conducted structured interviews for the completion of the medication history and the detection of adverse drug events (ADE). Relations between patient characteristics and hospitalisation were analysed using logistic regression. RESULTS Among the 14 511 included patients, 5972 (41.2%) were hospitalised including 69 deaths. In total, 7458 patients (51.4%) took more than 5 medications and 2846 patients (19.6%) had an ADE detected during the ED visit. In hospitalised patients, bleeding (32.2%) and metabolic disorders (16.8%) were the most observed ADE symptoms. Variables associated with increased hospital admission included 2 demographic variables (age, male gender), 4 clinical variables (renal and hepatic failures, alcohol addiction, ED visit for respiratory reason) and 6 medication-related variables (medications >5, use of blood, systemic anti-infective, metabolism and antineoplastic/immunomodulating medications and ADE). CONCLUSION We identified variables associated with hospitalisation including drug-related variables. These results point out the importance and the relevance of collecting medication data in a subacute medical ED (study registered on ClinicalTrials.gov, NCT03442010).
Collapse
Affiliation(s)
- Laura Lohan
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Gregory Marin
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marie Faucanie
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Marion Laureau
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Damien Perier
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Veronique Pinzani
- Medical Pharmacology and Toxicology Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Isabelle Giraud
- Economic Evaluation Unit, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Audrey Castet-Nicolas
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Anne Jalabert
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Maxime Villiet
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Mustapha Sebbane
- Emergency Medicine Department, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Cyril Breuker
- Clinical Pharmacy Department, CHU Montpellier, Univ Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France
| |
Collapse
|
18
|
Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department. Emerg Med Int 2021; 2021:2344212. [PMID: 34221509 PMCID: PMC8213466 DOI: 10.1155/2021/2344212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19-11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08-9.16), 6.38 (2.67-15.24), and 6.38 (2.41-16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age <65 years, but PCT lost its discrimination power for in-hospital mortality in patients with a bronchopulmonary infection site or a temperature ≥37.8°C and for ICU admission in patients with severe clinical presentations. PCT could be helpful in risk stratification, but several limitations must be considered, including being sometimes outperformed by a simple clinical examination.
Collapse
|
19
|
Chen QQ, Chiu SYH, Tsai LY, Hu RF. Validity of the Taiwan Triage and Acuity Scale in mainland China: a retrospective observational study. Emerg Med J 2021; 39:617-622. [PMID: 33827853 DOI: 10.1136/emermed-2019-208732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/23/2020] [Accepted: 02/28/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The Taiwan Triage and Acuity Scale (TTAS), developed for use in EDs, has been shown to be an excellent tool for triaging patients with high predictive performance, with an area under the receiver operating curve (AUROC) of 0.75. TTAS has been widely used in hospitals in Taiwan since 2010, but its utility has not been studied outside of Taiwan. Thus, the aim of this study was to evaluate the validity of using the TTAS in the ED of a tertiary hospital in mainland China to predict patient outcomes. METHODS A retrospective observational study was performed on patients 14 years of age or older attending the ED of a tertiary hospital in mainland China between 1 January 2016 and 31 March 2016. The validity of the TTAS in predicting hospital admission, intensive care unit (ICU) admission, death, ED length of stay (LOS) and ED resource utilisation was evaluated by determining the correlation of these outcomes with the TTAS, AUROC and test characteristics. RESULTS A total of 7843 patients were included in this study. There were significant differences between the TTAS categories in disposition, ED LOS and ED resource utilisation (p<0.0001). The TTAS was significantly correlated with patient disposition at discharge, hospital admission, ICU admission and death in the ED (Kendall rank correlations were 0.254, -0.254, -0.079 and -0.071, respectively; p=0.001). The AUROCs for the prediction of hospital admissions, ICU admissions and deaths in the ED were 0.749 (95% CI 0.732 to 0.765), 0.869 (95% CI 0.797 to 0.942) and 0.998 (95% CI 0.995 to 1.000), respectively. Our results demonstrated better performance using the TTAS for predictions of ICU admission and death. CONCLUSIONS The TTAS had good validity in predicting patient outcomes and ED resource utilisation in a tertiary hospital in mainland China. Compared with the performance of the TTAS in Taiwan, our results suggest that the TTAS can usefully be applied outside of Taiwan.
Collapse
Affiliation(s)
- Qing-Qing Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.,Nursing Department, Xiamen Chang Gung Hospital, Xiamen, China
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, Chang Gung University College of Management, Taoyuan, Taiwan.,Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Lai-Yin Tsai
- Nursing Department, Xiamen Chang Gung Hospital, Xiamen, China
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| |
Collapse
|
20
|
Gornet M, Leroux P, Ramont L, De Ruffi S, Giordano Orsini G, Losset X, Kanagaratnam L, Gennai S. Lack of admission biomarkers' clinical utility in outcomes prediction in patients suspected with infection in the emergency department. Am J Emerg Med 2021; 47:109-114. [PMID: 33799140 DOI: 10.1016/j.ajem.2021.03.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Initial procalcitonin (PCT) levels may fail in mortality and septic shock prediction and raise cost-effectiveness issues. Since measurement of lactate, C-reactive protein (CRP), white blood cells and neutrophils is common in the emergency department (ED), we compared prediction abilities of these biomarkers to PCT. METHODS From January 1st to December 31st, 2018, an observational, single center, retrospective study was conducted in the adult ED of the Reims University Hospital (France). Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit. RESULTS Over one year, 459 patients suspected with infection were included, of mean age 60.4 years (SD: 22.0), with 50.8% male, and 364 (79.3%) were hospitalized following ED visit. Overall, 45 (9.8%) patients had a bacteremia, 39 (8.5%) a septic shock and 54 (11.8%) died during their hospitalization. PCT and CRP showed the best discrimination for bacteremia, with an area under curve (AUC) of 0.68 for PCT and 0.65 for CRP. PCT and lactate showed similar good discriminative power for septic shock, with an AUC of 0.78 for both, and poor discrimination for in-hospital mortality, with an AUC of 0.62 for PCT and 0.69 for lactate. Systolic blood pressure and pulse oximetry showed similar discrimination for septic shock as PCT or lactate, while they showed higher discrimination for in-hospital mortality than PCT. CONCLUSION Usual admission biomarkers lack clinical utility in predicting septic shock or in-hospital mortality. CRP and PCT are poorly efficient in predicting bacteremia.
Collapse
Affiliation(s)
- Marion Gornet
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France
| | - Pierre Leroux
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France
| | - Laurent Ramont
- Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, SFR CAP-Santé (FED 4231), Laboratoire de Biochimie Médicale et Biologie Moléculaire, 51 rue Cognacq-Jay, 51100 Reims, France; CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire-MEDyC, 51 rue Cognacq-Jay, 51100 Reims, France.
| | - Sebastien De Ruffi
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France
| | - Guillaume Giordano Orsini
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France.
| | - Xavier Losset
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France.
| | - Lukshe Kanagaratnam
- Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France; Clinical Research Unit, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France.
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100 Reims, France; Université de Reims Champagne-Ardenne, UFR Médecine, 51 rue Cognacq-Jay, 51100 Reims, France.
| |
Collapse
|
21
|
Alesandrini M, Hauet M, Dezavelle S, Maria M, Borsa-Dorion A, Gatin A, Schweitzer C, Wiedemann A. How do the FIFA World Cup 2018 and the 2016 UEFA championships impact a pediatric emergency department? Arch Pediatr 2021; 28:234-237. [PMID: 33707103 DOI: 10.1016/j.arcped.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/19/2020] [Accepted: 02/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In France, soccer is the most popular sport, which today attracts a huge television audience with millions of spectators in the case of international competitions. During certain games with European top clubs, the attendance of adult emergencies is impacted. However, the impact of international soccer competitions on pediatric emergency department (PED) activity has not been evaluated. METHODS We performed a retrospective analysis of attendance in the PED of a tertiary university hospital in Nancy (France) during the UEFA 2016 championship and the FIFA 2018 World Cup. Games were represented by 2.5-h blocks and the tournament period was compared with the same period in the previous year. RESULTS Considering all games, we did not observe an impact of PED attendance. The admission rate was significantly lower during the final phase (11.1 patients per match vs. 13.9, P=0.037). We observed a decrease in consultations for trauma (4.9 vs. 6.7, P=0.006). The effects were higher during games involving the national French team, with a decrease in less severe admissions (P=0.034), attendance of older children (P=0.016), and the presence of the father as accompanying adult (P=0.002). During the two final matches, we observed a decrease of 14% in the total activity. CONCLUSION We found significant differences in PED attendance during two international soccer tournaments. It would be interesting to study this effect in countries other than France or in countries with different sport habits.
Collapse
Affiliation(s)
- M Alesandrini
- Service d'Accueil des Urgences Pédiatriques, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - M Hauet
- Service d'Accueil des Urgences Pédiatriques, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - S Dezavelle
- Service d'Anesthésie, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - M Maria
- Service de Réanimation Pédiatrique Spécialisée, CHRU Nancy, Rue du Morvan, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Borsa-Dorion
- Service d'Accueil des Urgences Pédiatriques, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Gatin
- Service d'Accueil des Urgences Pédiatriques, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Schweitzer
- Service d'Accueil des Urgences Pédiatriques, CHRU Nancy, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; Service de Réanimation Pédiatrique Spécialisée, CHRU Nancy, Rue du Morvan, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Wiedemann
- Service de Réanimation Pédiatrique Spécialisée, CHRU Nancy, Rue du Morvan, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; INSERM U-1256, 54505 Vandœuvre-lès-Nancy cedex, France.
| |
Collapse
|
22
|
Bouix-Picasso J. [Thoughts on the role of the advanced practice nurse in emergency care and the patient pathway]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2021; 66:46-51. [PMID: 33775304 DOI: 10.1016/s0038-0814(21)00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Abroad, advanced practice in emergency medicine has had positive effects on populations. In France, following the reform of emergency departments, advanced practice nurses in emergency medicine will become a reality. This new profession raises certain fears. Their contribution must be alongside the patients and in the organisations. For this, patient pathways need to be identified and cooperation between the advanced practice nurses and emergency room doctors must be established.
Collapse
Affiliation(s)
- Julien Bouix-Picasso
- Département de formation du personnel non médical, École du Val-de-Grâce, 1 place Laveran, 75005 Paris, France; Laboratoire Éducations et pratiques de santé (UR 3412), Université Sorbonne Paris Nord, 74 rue Marcel-Cachin, 93000 Bobigny, France; Faculté des sciences infirmières, Université de Montréal, pavillon Marguerite-d'Youville, 2375 chemin de la Côte-Sainte-Catherine, Montréal (Québec) H3T 1A8, Canada.
| |
Collapse
|
23
|
Peyrony O, Fontaine JP, Beaune S, Khoury A, Truchot J, Balen F, Vally R, Schmitt J, Ben Hammouda K, Roussel M, Borzymowski C, Vallot C, Sanh V, Azoulay E, Chevret S. EPICANCER-Cancer Patients Presenting to the Emergency Departments in France: A Prospective Nationwide Study. J Clin Med 2020; 9:jcm9051505. [PMID: 32429507 PMCID: PMC7291158 DOI: 10.3390/jcm9051505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
Abstract
Background: We aimed to estimate the prevalence of cancer patients who presented to Emergency Departments (EDs), report their chief complaint and identify the predictors of 30-day all-cause mortality. Patients and methods: we undertook a prospective, cross-sectional study during three consecutive days in 138 EDs and performed a logistic regression to identify the predictors of 30-day mortality in hospitalized patients. Results: A total of 1380 cancer patients were included. The prevalence of cancer patients among ED patients was 2.8%. The most frequent reasons patients sought ED care were fatigue (16.6%), dyspnea (16.3%), gastro-intestinal disorders (15.1%), trauma (13.0%), fever (12.5%) and neurological disorders (12.5%). Patients were admitted to the hospital in 64.9% of cases, of which 13.4% died at day 30. Variables independently associated with a higher mortality at day 30 were male gender (Odds Ratio (OR), 1.63; 95% CI, 1.04–2.56), fatigue (OR, 1.65; 95% CI, 1.01–2.67), poor performance status (OR, 3.00; 95% CI, 1.87–4.80), solid malignancy (OR, 3.05; 95% CI, 1.26–7.40), uncontrolled malignancy (OR, 2.27; 95% CI, 1.36–3.80), ED attendance for a neurological disorder (OR, 2.38; 95% CI, 1.36–4.19), high shock-index (OR, 1.80; 95% CI, 1.03–3.13) and oxygen therapy (OR, 2.68; 95% CI, 1.68–4.29). Conclusion: Cancer patients showed heterogeneity among their reasons for ED attendance and a high need for hospitalization and case fatality. Malignancy and general health status played a major role in the patient outcomes. This study suggests that the emergency care of cancer patients may be complex. Thus, studies to assess the impact of a dedicated oncology curriculum for ED physicians are warranted.
Collapse
Affiliation(s)
- Olivier Peyrony
- Department of Emergency Medicine, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France;
- Correspondence: ; Tel.: +33-1-42-49-84-04
| | - Jean-Paul Fontaine
- Department of Emergency Medicine, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 1 avenue Claude Vellefaux, 75010 Paris, France;
| | - Sébastien Beaune
- Department of Emergency Medicine, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France;
- INSERM UMRS 1144, Paris-Descartes University, 75006 Paris, France
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
| | - Abdo Khoury
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
- Department of Emergency Medicine & Critical Care, Besançon University Hospital, 25000 Besançon, France
| | - Jennifer Truchot
- Initiatives de Recherche aux Urgences (IRU) Research Network, Société Française de Médecine d’Urgence (SFMU), 75010 Paris, France; (A.K.); (J.T.)
- Department of Emergency Medicine, SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Faculty of Medicine, Paris Diderot University, 75010 Paris, France
| | - Frédéric Balen
- Department of Emergency Medicine, Toulouse University Hospital, 31059 Toulouse, France;
- Faculty of Medicine, Toulouse III—Paul Sabatier University, 31330 Toulouse, France
| | - Rishad Vally
- Department of Emergency Medicine, SAMU 33, Pellegrin University Hospital, 33000 Bordeaux, France;
| | - Jacques Schmitt
- Department of Emergency Medicine, SAMU 68, Mulhouse Hospital, 68100 Mulhouse, France;
| | | | - Mélanie Roussel
- Department of Emergency Medicine, Rouen University Hospital, F-76031 Rouen, France;
| | - Céline Borzymowski
- Department of Emergency Médicine, Jean Bernard Hospital, 59322 Valenciennes, France;
| | - Cécile Vallot
- Department of Emergency Medicine, Annecy Genevois Hospital, 74370 Annecy, France;
| | - Veronique Sanh
- Department of Emergency Medicine, SAMU 95, René Dubos Hospital, 95300 Pontoise, France;
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France;
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team. University of Paris, 75010 Paris, France;
| | - Sylvie Chevret
- Centre of Research in Epidemiology and StatisticS (CRESS), INSERM, UMR 1153, Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team. University of Paris, 75010 Paris, France;
- Department of Biostatistics and Medical Information, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, 75004 Paris, France
| |
Collapse
|
24
|
Balen F, Boyer A, Auboiroux P, Charpentier S. Qui sont les patients adressés en structure d'urgence par leur médecin traitant ? ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2019-0205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Acteur central du soin primaire, le médecin généraliste peut être amené à adresser des patients aux structures d’urgences (SU). Les objectifs de notre travail étaient d’évaluer l’incidence des patients adressés en SU par leur médecin traitant, d’évaluer leur gravité par rapport aux autres patients admis en SU et de connaître leur motif de consultation.
Méthode : Il s’agit d’une étude de cohorte se déroulant sur les SU adultes du CHU de Toulouse au cours d’une semaine de 2019. Tous les malades admis dans les SU ont été inclus. Les variables démographiques, le caractère « adressé par le médecin traitant » ou non, le score de tri initial sur la classification infirmière des malades aux urgences (CIMU) et l’hospitalisation post-SU ont été relevés.
Résultats : Sur les 2 289 passages dans les SU sur la période, 212 (9 %) étaient liés à des patients adressés par leur médecin traitant. Ces malades étaient plus âgés (58 ans vs 45 ans, p < 0,001), plus graves (taux de CIMU 3 plus élevés : 65 vs 38 %, p < 0,001) et plus souvent hospitalisés (39 vs 19 %, p < 0,001) que les patients admis en SU non adressés par leur médecin traitant. Le motif le plus fréquent d’admission était la douleur abdominale (21 %).
Discussion : Une attention particulière doit être portée sur les malades admis en SU adressés par leur médecin traitant. Ils semblent en effet plus graves et nécessitant plus de ressources hospitalières.
Collapse
|
25
|
Profile and Motivation of Patients Consulting in Emergency Departments While not Requiring Such a Level of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224431. [PMID: 31726697 PMCID: PMC6888183 DOI: 10.3390/ijerph16224431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2023]
Abstract
Consultations that do not require an emergency department (ED) level of care have increased. We explored attitudes of non-urgent patients in two academic hospitals in France with a similar fast track organization. One of them is a Parisian hospital with 90,000 patients/year who are admitted to the ED, while the other admits 40,000 patients/year in a smaller city. During one month in 2018, the triage nurse handed out a survey to patients coming for non-urgent consultations. It was given back to the fast track physician at the end of the visit; 598 patients agreed to answer. They were mostly young males with adequate social coverage, consulting for osteo-articular pathologies, without any significant difference between the two sites (p = 0.32). They were equally satisfied with the care they received (p = 0.38). Satisfaction was inversely correlated to waiting time (p < 0.0001). Convenience, accessibility of emergency facilities, and geographic proximity were motivation factors. These results suggest that primary care providers who can access testing facilities in accordance with patient needs might be a solution to help reduce overcrowding in EDs.
Collapse
|
26
|
The Temporal Trend in the Transfer of Older Adults to the Emergency Department for Traumatic Injuries: A Retrospective Analysis According to Their Place of Residence. J Am Med Dir Assoc 2019; 20:1462-1466. [DOI: 10.1016/j.jamda.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 01/07/2023]
|
27
|
Christiaens H, Charpentier S, Houze-Cerfon CH, Balen F. Winter virus season impact on acute dyspnoea in the emergency department. CLINICAL RESPIRATORY JOURNAL 2019; 13:722-727. [PMID: 31498565 DOI: 10.1111/crj.13081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the epidemiology of dyspnoea presented to emergency departments (EDs) during and of winter virus season (WVS). METHODS This is a monocentric retrospective cohort study. All patients attending to the ED of the Rangueil University Hospital (Toulouse, France) for dyspnoea in September 2016 (off WVS period) and January 2017 (during WVS period) were included. The primary endpoint was the final diagnosis. The patients' medical profiles, care duration, seriousness and futures were studied as secondary endpoints. RESULTS A total of 395 patients were studied: 125 patients during off-peak influenza season and 270 patients during the peak influenza season. The incidence of patients attending because of dyspnoea increased significantly during WVS (4.2% of ED presentations during the off WVS period versus 8.4% during the WVS period, P < 0.001). Patients attending the ED because of dyspnoea during WVS period were significantly older with more extensive medical backgrounds and more serious diseases. Most of those patients were hospitalized (54%), and largely in the geriatrics department. CONCLUSION The incidence of patients attending because of dyspnoea doubled during the WVS period, with patients who were older and had more complex histories. This time-consuming population largely requires hospitalization and may be one of the causes of the emergency department's overcrowding during epidemics.
Collapse
Affiliation(s)
- Hanae Christiaens
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, Toulouse, France.,Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 - EQUITY, INSERM, Toulouse, France.,Toulouse III - Paul Sabatier University, Toulouse, France
| | | | - Frederic Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France.,Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 - EQUITY, INSERM, Toulouse, France.,Toulouse III - Paul Sabatier University, Toulouse, France
| |
Collapse
|
28
|
Dugas S, Favrod-Coune T, Poletti PA, Huwyler T, Richard-Lepouriel H, Simon J, Sarasin FP, Rutschmann OT. Pitfalls in the triage and evaluation of patients with suspected acute ethanol intoxication in an emergency department. Intern Emerg Med 2019; 14:467-473. [PMID: 30552626 DOI: 10.1007/s11739-018-2007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
Acute ethanol intoxication (AEI) is frequent in emergency departments (EDs). These patients are at risk of mistriage, and to leave the ED without being seen. This study's objective was to describe the process and performance of triage and trajectory for patients with suspected AEI. Retrospective, observational study on adults admitted with a suspected AEI within 1 year at the ED of an urban teaching hospital. Data on the triage process, patients' characteristics, and their ED stay were extracted from electronic patient records. Predictors for leaving without being seen were identified using logistic regression analyzes. Of 60,488 ED patients within 1 year, 776 (1.3%) were triaged with suspected AEI. This population was young (mean age 38), primarily male (64%), and professionally inactive (56%). A large proportion were admitted on weekends (45%), at night (46%), and arrived by ambulance (85%). The recommendations of our triage scale were entirely respected in a minority of cases. In 22.7% of triage situations, a triage reason other than "alcohol abuse/intoxication" (such as suicidal ideation, head trauma or other substance abuse) should have been selected. Nearly, half of the patients (49%) left without being seen (LWBS). This risk was especially high amongst men (OR 1.56, 95% CI 1.12-2.19), younger patients (< 26 years of age; OR 1.97, 95% CI 1.16-3.35), night-time admissions (OR 1.97, 95% CI 1.16-3.35), and patients assigned a lower emergency level (OR 2.32, 95% CI 1.58-3.42). Despite a standardized triage protocol, patients admitted with suspected AEI are at risk of poor assessment, and of not receiving optimal care.
Collapse
Affiliation(s)
- Sarah Dugas
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Thierry Favrod-Coune
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Tibor Huwyler
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry and Faculty of Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Josette Simon
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - François P Sarasin
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland
| | - Olivier T Rutschmann
- Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and Geneva University, Faculty of Medicine, Geneva, Switzerland.
| |
Collapse
|
29
|
Peyrony O, Dumas G, Legay L, Principe A, Franchitti J, Simonetta M, Verrat A, Amami J, Milacic H, Bragança A, Gillet A, Resche-Rigon M, Fontaine JP, Azoulay E. Central venous oxygen saturation is not predictive of early complications in cancer patients presenting to the emergency department. Intern Emerg Med 2019; 14:281-289. [PMID: 30306323 DOI: 10.1007/s11739-018-1966-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/06/2018] [Indexed: 12/14/2022]
Abstract
Central venous oxygen saturation (ScvO2) is easily observable in oncology patients with long-term central venous catheters (CVC), and has been studied as a prognostic factor in patients with sepsis. We sought to investigate the association between ScvO2 and early complications in cancer patients presenting to the ED. We prospectively enrolled adult cancer patients with pre-existing CVC who presented to the ED. ScvO2 was measured on their CVC. The outcome was admission to the intensive care unit (ICU) or mortality by day 7. ScvO2 was first studied as a continuous variable (%) with a ROC analysis and as a categorical variable (cut-off at < 70%) with a multivariate analysis. A total of 210 cancer patients were enrolled. At baseline, ScvO2 showed no significant difference between patients who were admitted to the ICU or died before day 7, and patients who did not (67%; IQR 62-68% vs. 71%; IQR 65-78% respectively, P = 0.3). The ROC analysis showed the absence of discrimination accuracy for ScvO2 to predict the outcome (AUC = 0.56). By multivariate analysis, ScvO2 < 70% was not associated with the outcome (OR 1.67; 95% CI 0.64-4.36). Variables that were associated with ICU admission or death by day 7 included a shock-index (heart rate/systolic blood pressure) > 1 and a performance status > 2 (OR 4.76; 95% CI 1.81-12.52 and OR 6.23, 95% CI 2.40-16.17, respectively). This study does not support the use of ScvO2 to risk stratify cancer patients presenting to the ED.
Collapse
Affiliation(s)
- Olivier Peyrony
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Guillaume Dumas
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Léa Legay
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alessandra Principe
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jessica Franchitti
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marie Simonetta
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Verrat
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jihed Amami
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Hélène Milacic
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Adélia Bragança
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ariane Gillet
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Matthieu Resche-Rigon
- Biostatistics and Medical Information Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM-UMR1153), ECSTRRA Team, Paris, France
- Paris Diderot University, Paris, France
| | - Jean-Paul Fontaine
- Emergency Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elie Azoulay
- Intensive Care Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM-UMR1153), ECSTRRA Team, Paris, France
- Paris Diderot University, Paris, France
| |
Collapse
|
30
|
Abstract
BACKGROUND Long boarding time in emergency department (ED) leads to increased morbidity and mortality. Prediction of admissions upon triage could improve ED care efficiency and decrease boarding time. OBJECTIVE To develop a real-time automated model (MA) to predict admissions upon triage and compare this model with triage nurse prediction (TNP). PATIENTS AND METHODS A cross-sectional study was conducted in four EDs during 1 month. MA used only variables available upon triage and included in the national French Electronic Emergency Department Abstract. For each patient, the triage nurse assessed the hospitalization risk on a 10-point Likert scale. Performances of MA and TNP were compared using the area under the receiver operating characteristic curves, the accuracy, and the daily and hourly mean difference between predicted and observed number of admission. RESULTS A total of 11 653 patients visited the EDs, and 19.5-24.7% were admitted according to the emergency. The area under the curves (AUCs) of TNP [0.815 (0.805-0.826)] and MA [0.815 (0.805-0.825)] were similar. Across EDs, the AUCs of TNP were significantly different (P < 0.001) in all EDs, whereas AUCs of MA were all similar (P>0.2). Originally, using daily and hourly aggregated data, the percentage of errors concerning the number of predicted admission were 8.7 and 34.4%, respectively, for MA and 9.9 and 35.4%, respectively, for TNP. CONCLUSION A simple model using variables available in all EDs in France performed well to predict admission upon triage. However, when analyzed at an hourly level, it overestimated the number of inpatient beds needed by a third. More research is needed to define adequate use of these models.
Collapse
|
31
|
Ghazali DA, Kenway P, Clery R, Choquet C, Casalino E. A multicenter randomized control trial evaluating professional practice assessment of patient pain management after simulation training course: Study protocol. Contemp Clin Trials Commun 2019; 14:100331. [PMID: 30793056 PMCID: PMC6370573 DOI: 10.1016/j.conctc.2019.100331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/19/2019] [Accepted: 01/26/2019] [Indexed: 11/16/2022] Open
Abstract
Aims Pain is underestimated and insufficiently treated in Emergency Departments (ED). The primary objective of this multicenter, prospective, observational, and interventional study is to analyze the clinical impact of a simulation-based training for Emergency Nurses on pain assessment and management. Secondary objectives are to measure instructed staff's satisfaction with the simulation training and to evaluate the progress of participants as well as studying the clinical impact of this course: level of correlation between accuracy of analgesia and level of pain, assessment of patient and caregiver satisfaction. Design this study will be undertaken in EDs at two university hospitals (Paris, France: Bichat and Beaujon) with randomly selected experimental and control groups. Methods During the first phase, inventories in the EDs of current professional practice will be realized. Then, the control group will have theoretical classes and the experimental group will have both the theoretical class and simulation courses for all the nurses (with simulated patients in trauma pain scenarios). Post course assessment will be established of triage nurses' and other nurses’ practice changes concerning trauma pain management in EDs. Moreover, this study will include an assessment of the impact on patient and caregiver satisfaction. All patients over 18 years old who are admitted to the ED for a non-vital trauma are included. Exclusion criteria are patients who are admitted by an EMS ambulance. Clinical implication this study seeks to demonstrate that the implementation of a theoretical course combined with a simulation session will improve pain management in EDs by Emergency Nurses.
Collapse
Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department, University Hospital of Bichat, Paris, France.,Simulation Center of Ilumens, University of Paris-Diderot, Paris, France
| | - Philippe Kenway
- Emergency Department, University Hospital of Bichat, Paris, France
| | - Richard Clery
- Emergency Department, University Hospital of Bichat, Paris, France
| | | | - Enrique Casalino
- Emergency Department, University Hospital of Bichat, Paris, France.,Emergency Department, University Hospital of Beaujon, Clichy, France.,EA 7335 REMES, University of Paris-Diderot, Paris, France
| |
Collapse
|
32
|
Taboulet P, Maillard-Acker C, Ranchon G, Goddet S, Dufau R, Vincent-Cassy C, Yordanov Y, El Khoury C. Triage des patients à l’accueil d’une structure d’urgences. Présentation de l’échelle de tri élaborée par la Société française de médecine d’urgence : la FRench Emergency Nurses Classification in Hospital (FRENCH). ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
La Société française de médecine d’urgence
(SFMU) a recommandé la création d’une échelle spécifique, unique au niveau national, pour le triage des patients à l’accueil d’une structure d’urgences, prenant en compte les spécificités de l’adulte et de l’enfant. La commission de l’évaluation et de la qualité de la SFMU a créé, à l’instar des échelles de tri internationales, une échelle de tri avec cinq niveaux de priorité croissante (tris 5 à 1, du moins urgent au plus urgent) auxquels correspondent des motifs de recours aux soins de complexité/sévérité croissante. Le tri 3 a été subdivisé en deux groupes pour distinguer (et prioriser) les patients qui ont au moins une comorbidité en rapport avec le motif de recours aux soins ou qui sont adressés par un médecin (3A) des autres patients (3B). L’échelle de tri FRENCH (FRench Emergency Nurses Classification in Hospital) a donc six niveaux de priorité. À chaque niveau de tri correspondent des motifs de recours aux soins fréquents en médecine d’urgence, des modulateurs de tri, une répartition rationnelle des circuits patients et un délai maximum d’attente avant prise en charge médicale, après évaluation par l’infirmier(ière) d’accueil. Une première évaluation de la FRENCH a montré qu’elle répondait aux objectifs du triage en facilitant le repérage de l’urgence complexe/sévère de façon fiable et reproductible. De nouvelles évaluations sont nécessaires dans d’autres structures d’urgences pour confirmer sa performance et favoriser son évolution.
Collapse
|
33
|
Taboulet P, Vincent-Cassy C, Squara PA, Resche-Rigon M. Validité de la FRENCH, l’échelle de tri des urgences hospitalières élaborée par la Société française de médecine d’urgence. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : La Société française de médecine d’urgence a créé en 2016 une échelle de tri pour les infirmier( ière)s d’accueil dans une structure d’urgences. Cette échelle appelée FRENCH (FRench Emergency Nurses Classification in Hospital) classe les tris de 5 à 1 (du moins urgent au plus urgent) en fonction du pronostic et de la complexité/ sévérité des motifs de recours aux soins. Le tri 3, groupe hétérogène dans les échelles de tri internationales, a été subdivisé en deux niveaux pour prioriser les patients qui ont une comorbidité en rapport avec le motif de recours aux soins ou qui sont adressés par un médecin et qui sont prioritaires (3A) par rapport aux autres patients (3B).
Objectif : Évaluer la pertinence de la FRENCH.
Méthode : Nous avons analysé les données démographiques, les paramètres vitaux, les examens complémentaires prescrits et les durées de prise en charge de tous les patients accueillis dans un hôpital universitaire sur une période de neuf mois consécutifs. Le critère de jugement était l’existence d’une relation croissante entre le niveau de complexité/ sévérité des patients — reflétée par le taux d’hospitalisation et la prescription d’examens complémentaires—et le niveau de priorité du tri.
Résultats : L’étude a inclus 27 598 patients. La répartition des patients par niveaux de tri était : 0,4 (tri 1), 6,7 (tri 2), 13,3 (tri 3A), 29,4 (tri 3B), 43,1 (tri 4) et 7,1 % (tri 5). Le taux d’hospitalisation était croissant quand l’ordre de priorité augmentait. La relation entre les niveaux de tri et le taux d’hospitalisation mesurée par l’aire sous la courbe (0,83 : intervalle de confiance à 95 % : [0,82–0,83]) était bonne. La prescription des examens complémentaires était croissante quand l’ordre de priorité augmentait. La corrélation entre les niveaux de tri et un indice global d’examens complémentaires prescrits était modérée (K = 0,51).
Conclusion : Cette étude monocentrique valide la pertinence de l’échelle de tri FRENCH à six niveaux par sa bonne capacité à classer les patients selon leur complexité/sévérité. De nouvelles évaluations sont nécessaires dans d’autres structures d’urgences pour confirmer sa performance et favoriser son évolution.
Collapse
|
34
|
Abstract
Background The Swiss Emergency Triage Scale (SETS) is a four-level emergency scale that previously showed moderate reliability and high rates of undertriage due to a lack of standardization. It was revised to better standardize the measurement and interpretation of vital signs during the triage process. Objective The aim of this study was to explore the inter-rater and test–retest reliability, and the rate of correct triage of the revised SETS. Patients and methods Thirty clinical scenarios were evaluated twice at a 3-month interval using an interactive computerized triage simulator by 58 triage nurses at an urban teaching emergency department admitting 60 000 patients a year. Inter-rater and test–retest reliabilities were determined using κ statistics. Triage decisions were compared with a gold standard attributed by an expert panel. Rates of correct triage, undertriage, and overtriage were computed. A logistic regression model was used to identify the predictors of correct triage. Results A total of 3387 triage situations were analyzed. Inter-rater reliability showed substantial agreement [mean κ: 0.68; 95% confidence interval (CI): 0.60–0.78] and test–retest almost perfect agreement (mean κ: 0.86; 95% CI: 0.84–0.88). The rate of correct triage was 84.1%, and rates of undertriage and overtriage were 7.2 and 8.7%, respectively. Vital sign measurement was an independent predictor of correct triage (odds ratios for correct triage: 1.29 for each additional vital sign measured, 95% CI: 1.20–1.39). Conclusion The revised SETS incorporating standardized vital sign measurement and interpretation during the triage process resulted in high reliability and low rates of mistriage.
Collapse
|
35
|
Naouri D, El Khoury C, Vincent-Cassy C, Vuagnat A, Schmidt J, Yordanov Y. The French Emergency National Survey: A description of emergency departments and patients in France. PLoS One 2018; 13:e0198474. [PMID: 29902197 PMCID: PMC6002101 DOI: 10.1371/journal.pone.0198474] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/18/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some major changes have occurred in emergency department (ED) organization since the early 2000s, such as the establishment of triage nurses and short-track systems. The objectives of this study were to describe the characteristics of French EDs organization and users, based on a nationwide cross-sectional survey. METHODS The French Emergency Survey was a nationwide cross-sectional survey. All patients presenting to all EDs during a 24-hr period of June 2013 were included. Data collection concerned ED characteristics as well as patient characteristics. RESULTS Among the 736 EDs in France, 734 were surveyed. Triage nurses and short-track systems were respectively implemented in 73% and 41% of general EDs. The median proportion of patients aged > 75 years was 14% and median hospitalisation rate was 20%. During the study period, 48,711 patients presented to one of the 734 EDs surveyed. Among them, 7% reported having no supplementary health or universal coverage (for people with lower incomes). Overall, 50% of adult patients had been seen by the triage nurse in less than 5 minutes, 74% had a time to first medical contact shorter than one hour and 55% had an ED length of stay shorter than 3 hours. CONCLUSION The French Emergency Survey is the first study to provide data on almost all EDs in France. It underlines how ED organization has been redesigned to face the increase in the annual census. French EDs appear to have a particular role for vulnerable people: age-related vulnerability and socio-economic vulnerability with an over-representation of patients without complementary health coverage.
Collapse
Affiliation(s)
- Diane Naouri
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carlos El Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- Univ. Lyon, Claude Bernard Lyon 1 University, HESPER EA 7425, Lyon, France
| | - Christophe Vincent-Cassy
- Emergency Département, Hôpital Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Albert Vuagnat
- Directorate for Research, Studies, Evaluation and Statistics of the French Health and Social Affairs Ministry, Paris, France
| | - Jeannot Schmidt
- Emergency Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- EA 4679, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Youri Yordanov
- Sorbonne Universités, UPMC Paris Univ-06, Paris, France
- Emergency Département, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, U1153, Paris, France - Centre d’Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique–Hôpitaux de Paris (APHP), Paris, France
| | | |
Collapse
|
36
|
Dechamps M, Castanares-Zapatero D, Manara A. Combination of clinical and ECG criteria may increase validity of triage scales: authors' reply. Intern Emerg Med 2017; 12:1333-1334. [PMID: 28150087 DOI: 10.1007/s11739-017-1617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Melanie Dechamps
- Emergency Department,Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.
- Intensive Care UnitCliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.
| | - Diego Castanares-Zapatero
- Intensive Care UnitCliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Alessandro Manara
- Emergency Department,Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| |
Collapse
|
37
|
Dechamps M, Castanares-Zapatero D, Berghe PV, Meert P, Manara A. Comparison of clinical-based and ECG-based triage of acute chest pain in the Emergency Department. Intern Emerg Med 2017; 12:1245-1251. [PMID: 27796707 DOI: 10.1007/s11739-016-1558-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/20/2016] [Indexed: 01/23/2023]
Abstract
In the Emergency Department, chest pain triage systems are based on either clinical features or ECG recording. In this prospective, single-center, observational study, we aimed to compare the diagnostic performance of these triage systems in distinguishing acute coronary syndromes (ACS) from diseases of mild severity. Patients were sorted into the triage systems based on collected data at admission and on a systematic 12-lead ECG performed at triage. The final diagnosis was determined after a 30-day follow-up. For ACS, we determined a high-acuity triage score (Level 1 or 2) as being adequate, and for mild severity diseases a low-acuity triage score (Level 3, 4 or 5) as being adequate. The diagnostic performance of all studied systems was moderate (AUC from 0.644 to 0.694), with no statistically significant difference found between them. However, characteristics of the systems differed because the clinical-based systems had a higher sensitivity (87-91%) but lower specificity (32-39%) compared with the ECG-based system (sensitivity 62% and specificity 64%). A higher sensitivity limits the risk of a patient with acute coronary syndrome staying unsafely in the waiting room, while a higher specificity prevents overcrowding. ECG at triage also ensures that no STEMIs or high-risk NSTEMIs are missed. Based on these findings, each Emergency Depatment could more accurately select the triage system that fits their local particularities.
Collapse
Affiliation(s)
- Melanie Dechamps
- Emergency Department, Clinique Universitaire Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium.
- Emergency Department, Universitair Zienkenhuis Gent, Universiteit Gent, 9000, Ghent, Belgium.
| | - Diego Castanares-Zapatero
- Intensive Care Unit, Clinique Universitaire Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Patrick Vanden Berghe
- Emergency Department, Clinique Universitaire Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Philippe Meert
- Emergency Department, Clinique Universitaire Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Alessandro Manara
- Emergency Department, Clinique Universitaire Saint Luc, Université Catholique de Louvain, 1200, Brussels, Belgium
| |
Collapse
|
38
|
Kuriyama A, Urushidani S, Nakayama T. Five-level emergency triage systems: variation in assessment of validity. Emerg Med J 2017; 34:703-710. [PMID: 28751363 DOI: 10.1136/emermed-2016-206295] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 04/19/2017] [Accepted: 05/05/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Triage systems are scales developed to rate the degree of urgency among patients who arrive at EDs. A number of different scales are in use; however, the way in which they have been validated is inconsistent. Also, it is difficult to define a surrogate that accurately predicts urgency. This systematic review described reference standards and measures used in previous validation studies of five-level triage systems. METHODS We searched PubMed, EMBASE and CINAHL to identify studies that had assessed the validity of five-level triage systems and described the reference standards and measures applied in these studies. Studies were divided into those using criterion validity (reference standards developed by expert panels or triage systems already in use) and those using construct validity (prognosis, costs and resource use). RESULTS A total of 57 studies examined criterion and construct validity of 14 five-level triage systems. Criterion validity was examined by evaluating (1) agreement between the assigned degree of urgency with objective standard criteria (12 studies), (2) overtriage and undertriage (9 studies) and (3) sensitivity and specificity of triage systems (7 studies). Construct validity was examined by looking at (4) the associations between the assigned degree of urgency and measures gauged in EDs (48 studies) and (5) the associations between the assigned degree of urgency and measures gauged after hospitalisation (13 studies). Particularly, among 46 validation studies of the most commonly used triages (Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System), 13 and 39 studies examined criterion and construct validity, respectively. CONCLUSION Previous studies applied various reference standards and measures to validate five-level triage systems. They either created their own reference standard or used a combination of severity/resource measures.
Collapse
Affiliation(s)
- Akira Kuriyama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.,Department of General Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Seigo Urushidani
- Department of Emergency Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| |
Collapse
|
39
|
Dalwai M, Valles P, Twomey M, Nzomukunda Y, Jonjo P, Sasikumar M, Nasim M, Razaaq A, Gayraud O, Jecrois PR, Wallis L, Tayler-Smith K. Is the South African Triage Scale valid for use in Afghanistan, Haiti and Sierra Leone? BMJ Glob Health 2017; 2:e000160. [PMID: 28912964 PMCID: PMC5594211 DOI: 10.1136/bmjgh-2016-000160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/13/2017] [Accepted: 02/22/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the validity of the South African Triage Scale (SATS) in four Médecins Sans Frontières (MSF)-supported emergency departments (ED, two trauma-only sites, one mixed site (both medical and trauma cases) and one paediatric-only site) in Afghanistan, Haiti and Sierra Leone. Methods This was a retrospective cohort study conducted between June 2013 and June 2014. Validity was assessed by comparing patients’ SATS ratings with their final ED outcome (ie, hospital admission, death or discharge). Results In the two trauma settings, the SATS demonstrated good validity: it accurately predicted an increase in the likelihood of mortality and hospitalisation across incremental acuity levels (p<0.001) and ED outcomes for ‘green’ and ‘red’ patients matched the predicted ED outcomes in 84%–99% of cases. In the mixed ED, the SATS was able to predict an incremental increase in hospitalisation (p<0.001) across both trauma and non-trauma cases. In the paediatric-only settings, SATS was able to predict an incremental increase in hospitalisation in the non-trauma cases only (p<0.001). However, 87% (non-trauma) and 94% (trauma) of ‘red’ patients in the mixed-medical setting were overtriaged and 76% (non-trauma) and 100% (trauma) of ‘green’ patients in the paediatric settings were undertriaged. Conclusion The SATS is a valid tool for trauma-only settings in low-resource countries. Its use in mixed settings seems justified, but context-specific assessments would seem prudent. Finally, in paediatric settings with endemic malaria, adding haemoglobin level to the SATS discriminator list may help to improve the undertriage of patients with malaria.
Collapse
Affiliation(s)
- Mohammed Dalwai
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.,Operational Research Unit Luxembourg, Médecins Sans Frontières, Luxembourg
| | - Pola Valles
- Medical department, Médecins Sans Frontières, Operational CentreBrussels, Belgium
| | - Michele Twomey
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Yvonne Nzomukunda
- Medical department, Médecins Sans Frontières, Free Town, Sierra Leone
| | - Prince Jonjo
- Medical department, Médecins Sans Frontières, Free Town, Sierra Leone
| | - Manoj Sasikumar
- Medical department, Médecins Sans Frontières, Free Town, Sierra Leone
| | - Masood Nasim
- Medical department, Médecins Sans Frontières, Kabul, Afghanistan
| | - Abdul Razaaq
- Medical department, Médecins Sans Frontières, Kabul, Afghanistan
| | - Olivia Gayraud
- Medical department, Médecins Sans Frontières, Port au Prince, Haiti
| | | | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Katie Tayler-Smith
- Operational Research Unit Luxembourg, Médecins Sans Frontières, Luxembourg
| |
Collapse
|
40
|
Peres J, Mendes KLC, Wada RS, Sousa MDLRD. Relationship between risk classifications used to organize the demand for oral health in a small city of São Paulo, Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:1905-1911. [PMID: 28614510 DOI: 10.1590/1413-81232017226.00702016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/12/2016] [Indexed: 11/22/2022] Open
Abstract
Oral health teams can work with both information of the people related to the family context as individual epidemiological through risk ratings, considering equity and service organization. The purpose of our study was to evaluate the association between tools that classify individual and family risk. The study group consisted of students from the age group of 5-6 years and 11-12 years who were classified regarding risk of caries and whether their parents had periodontal disease, in addition to the family risk. There was an association between the risk rating for decay in children (n = 128) and family risk classification with Coef C = 0.338 and p = 0.01, indicating that the higher the family's risk, the higher the risk of caries. Similarly, the association between the risk classification for periodontal disease in parents and family risk classification with Coef C = 0.5503 and p = 0.03 indicated that the higher the family risk, the higher the risk of periodontal disease. It can be concluded that the use of family risk rating tool is indicated as a possibility of ordering actions of the dental service, organizing their demand with greater equity, in this access door.
Collapse
Affiliation(s)
- João Peres
- Departamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Areião. 13414-903 Piracicaba SP Brasil.
| | - Karine Laura Cortellazzi Mendes
- Departamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Areião. 13414-903 Piracicaba SP Brasil.
| | | | - Maria da Luz Rosario de Sousa
- Departamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas. Av. Limeira 901, Areião. 13414-903 Piracicaba SP Brasil.
| |
Collapse
|
41
|
Pouessel A, Chauvin A, Truchot J, Resche-Rigon M, Galichon B, Plaisance P. Évaluation d’un nouvel outil d’information dans un service d’Urgence. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.126.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
42
|
Hasselbalch RB, Plesner LL, Pries-Heje M, Ravn L, Lind M, Greibe R, Jensen BN, Rasmussen LS, Iversen K. The Copenhagen Triage Algorithm: a randomized controlled trial. Scand J Trauma Resusc Emerg Med 2016; 24:123. [PMID: 27724978 PMCID: PMC5057417 DOI: 10.1186/s13049-016-0312-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/30/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Crowding in the emergency department (ED) is a well-known problem resulting in an increased risk of adverse outcomes. Effective triage might counteract this problem by identifying the sickest patients and ensuring early treatment. In the last two decades, systematic triage has become the standard in ED's worldwide. However, triage models are also time consuming, supported by limited evidence and could potentially be of more harm than benefit. The aim of this study is to develop a quicker triage model using data from a large cohort of unselected ED patients and evaluate if this new model is non-inferior to an existing triage model in a prospective randomized trial. METHODS The Copenhagen Triage Algorithm (CTA) study is a prospective two-center, cluster-randomized, cross-over, non-inferiority trial comparing CTA to the Danish Emergency Process Triage (DEPT). We include patients ≥16 years (n = 50.000) admitted to the ED in two large acute hospitals. Centers are randomly assigned to perform either CTA or DEPT triage first and then use the other triage model in the last time period. The CTA stratifies patients into 5 acuity levels in two steps. First, a scoring chart based on vital values is used to classify patients in an immediate category. Second, a clinical assessment by the ED nurse can alter the result suggested by the score up to two categories up or one down. The primary end-point is 30-day mortality and secondary end-points are length of stay, time to treatment, admission to intensive care unit, and readmission within 30 days. DISCUSSION If proven non-inferior to standard DEPT triage, CTA will be a faster and simpler triage model that is still able to detect the critically ill. Simplifying triage will lessen the burden for the ED staff and possibly allow faster treatment. TRIAL REGISTRATION Clinicaltrials.gov: NCT02698319 , registered 24. of February 2016, retrospectively registered.
Collapse
Affiliation(s)
| | | | - Mia Pries-Heje
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Lisbet Ravn
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Morten Lind
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Rasmus Greibe
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Lars S. Rasmussen
- Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| |
Collapse
|
43
|
Saidi K, Paquet A, Goulet H, Ameur F, Bouhaddou A, Nion N, Riou B, Hausfater P. Effets de la création d’un circuit court au sein d’un service d’urgence adulte. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0593-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
44
|
Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L, Kutz A, Conca A, Reutlinger B, Canavaggio P, Sauvin G, Bernard M, Huber A, Mueller B. Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Crit Care 2015; 19:377. [PMID: 26511878 PMCID: PMC4625457 DOI: 10.1186/s13054-015-1098-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/10/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Early risk stratification in the emergency department (ED) is vital to reduce time to effective treatment in high-risk patients and to improve patient flow. Yet, there is a lack of investigations evaluating the incremental usefulness of multiple biomarkers measured upon admission from distinct biological pathways for predicting fatal outcome and high initial treatment urgency in unselected ED patients in a multicenter and multinational setting. METHOD We included consecutive, adult, medical patients seeking ED care into this observational, cohort study in Switzerland, France and the USA. We recorded initial clinical parameters and batch-measured prognostic biomarkers of inflammation (pro-adrenomedullin [ProADM]), stress (copeptin) and infection (procalcitonin). RESULTS During a 30-day follow-up, 331 of 7132 (4.6 %) participants reached the primary endpoint of death within 30 days. In logistic regression models adjusted for conventional risk factors available at ED admission, all three biomarkers strongly predicted the risk of death (AUC 0.83, 0.78 and 0.75), ICU admission (AUC 0.67, 0.69 and 0.62) and high initial triage priority (0.67, 0.66 and 0.58). For the prediction of death, ProADM significantly improved regression models including (a) clinical information available at ED admission (AUC increase from 0.79 to 0.84), (b) full clinical information at ED discharge (AUC increase from 0.85 to 0.88), and (c) triage information (AUC increase from 0.67 to 0.83) (p <0.01 for each comparison). Similarly, ProADM also improved clinical models for prediction of ICU admission and high initial treatment urgency. Results were robust in regard to predefined patient subgroups by center, main diagnosis, presenting symptoms, age and gender. CONCLUSIONS Combination of clinical information with results of blood biomarkers measured upon ED admission allows early and more adequate risk stratification in individual unselected medical ED patients. A randomized trial is needed to answer the question whether biomarker-guided initial patient triage reduces time to initial treatment of high-risk patients in the ED and thereby improves patient flow and clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01768494 . Registered January 9, 2013.
Collapse
Affiliation(s)
- Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
| | - Pierre Hausfater
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Devendra Amin
- Department of critical care, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL, 33756, USA.
| | - Adina Amin
- Department of critical care, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL, 33756, USA.
| | - Sebastian Haubitz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Lukas Faessler
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Antoinette Conca
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Barbara Reutlinger
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Pauline Canavaggio
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Gabrielle Sauvin
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Maguy Bernard
- Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France.
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Beat Mueller
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
| |
Collapse
|
45
|
To score or not to score during triage in the emergency department? Intensive Care Med 2015; 41:1135-7. [PMID: 25971384 DOI: 10.1007/s00134-015-3814-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
|
46
|
Évaluation de la classification infirmière des malades aux urgences (CIMU) : généralisation des résultats. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
47
|
Évaluation de l’application d’un triage par la Classification Infirmière des Malades aux Urgences par des infirmiers organisateurs de l’accueil en comparaison avec un triage réalisé par un médecin. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0535-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Inter-rater reliability and validity of the Ministry of Health of Turkey's mandatory emergency triage instrument. Emerg Med Australas 2015; 27:210-5. [DOI: 10.1111/1742-6723.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/26/2022]
|
49
|
Parenti N, Reggiani MLB, Iannone P, Percudani D, Dowding D. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud 2014; 51:1062-9. [PMID: 24613653 DOI: 10.1016/j.ijnurstu.2014.01.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/20/2013] [Accepted: 01/24/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To conduct a systematic review to check the level of validity and reliability of the Manchester Triage System and the quality of reporting of literature on this topic. DESIGN This is a systematic review based on the PRISMA guideline on reporting systematic reviews. DATA SOURCES The systematic search of the international literature published from 1997 through 30 November 2012 in the PubMed, Embase, Cochrane Library, Cinahl, Web of Knowledge, and Scopus databases. REVIEW METHODS This review included quantitative and qualitative research investigating the reliability and validity of the Manchester Triage System for the broad population of adults and children visiting the emergency department. After a systematic selection process, included studies were assessed on their quality by three researchers using the STARD guidelines. RESULTS Twelve studies were included in the review. The studies investigated the inter- and intra-rater reliability using the "kappa" statistic; the validity was tested with many measures: validity in predicting mortality, hospital admission, under- and overtriage, used resources, and length of stay in the emergency department, as well as a reference standard rating. CONCLUSIONS In this review, the Manchester Triage System shows a wide inter-rater agreement range with a prevalence of good and very good agreement. Its safety was low because of the high rate of undertriage and the low sensitivity in predicting higher urgency levels. The high rate of overtriage could cause unnecessarily high use of resources in the emergency department. The quality of the reporting in studies of the reliability and validity of the Manchester Triage System is good.
Collapse
Affiliation(s)
| | | | - Primiano Iannone
- Department of Emergency Medicine of Hospital Lavagna, Genova, Italy
| | | | - Dawn Dowding
- Columbia University School of Nursing and Visiting Nursing Service of New York, New York, USA
| |
Collapse
|
50
|
L’infirmière organisatrice de l’accueil (IOA) : rôle et fonctions. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-013-0727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|