The Role Descriptions of Triage Nurse in Emergency Department: A Delphi Study

Optimizing triage education for emergency room nurses: A scoping review

AIMS

Accurate triage decisions by emergency room nurses are pivotal for patient prognosis and efficient utilization of resources. This study aimed to identify teaching methods, contents, intervention characteristics, and initial consideration of educational design for the development of triage education, targeting triage nurses.

DESIGN

A scoping review.

DATA SOURCES

PubMed, CINAHL, Web of Science, Embase, and RISS were searched for studies in either English or Korean, regardless of publication year.

REVIEW METHODS

The review was conducted according to the Joanna Briggs Institute guidelines. Studies published before November 15, 2023 were selected, based on the following index terms in each database: nurses, triage, education, and emergency services, hospital.

RESULTS

Of the 20 studies included in this review, five focused on severity classification of patients with cardiovascular diseases, one addressed infectious diseases, two examined pediatric patients, one explored patients with trauma, and the remaining eleven were not limited to specific diseases. Eleven studies (55 %) employed face-to-face (offline) education, whereas six (30 %) used non-face-to-face (online) education. The teaching methods were classified as teacher-centered learning and student-centered learning. The educational strategies included in-person lectures, online classes, demonstrations, simulations, mobile technology or web-based programs, group discussions, role-plays, and flipped learning. Outcome variables, such as triage accuracy, knowledge, performance ability, self-efficacy, satisfaction, wait time, and competency were measured as intervention effects.

CONCLUSIONS

This review demonstrates the key characteristics and contents of triage education interventions, along with key considerations in the initial design stages. Triage education covers a wide range of contents and diverse teaching methods pertinent to severity classification in triage practice. Effective educational programs hinge on the meticulous planning of objectives, optimal selection of the target population, needs assessment, and suitable teaching methods and materials. Future triage education for emergency room nurses should be tailored to specific participants while anticipating and planning all potential circumstances of implementation.

Characteristics of undertriaged older patients in the emergency department: Retrospective study

BACKGROUND

Older patients are more likely to be undertriaged as they often suffer from multiple diseases and complain of non-specific symptoms. Therefore, it is necessary to identify the characteristics of undertriaged older patients in emergency departments.

METHODS

This descriptive study retrospectively reviewed and analyzed the electronic medical records of older patients who visited the emergency department of a general hospital in Seoul between January and December 2019.

RESULTS

Approximately 29 % (n = 4,823) of older patients who visited the emergency department during the study period were classified as Korean Triage and Acuity Scale (KTAS) level 4 or 5, and approximately 8 % (n = 397) were undertriaged. Approximately 73 % (n = 288) of patients were hospitalized after visiting the emergency department. The undertriaged older patients exhibited nervous system symptoms such as dizziness and headache (28.8 %), cardiopulmonary symptoms such as chest discomfort, palpitations, and abdominal pain (28.4 %), head trauma (12.8 %), and respiratory symptoms such as cough and dyspnea (12.5 %).

CONCLUSION

Triage nurses in emergency departments should carefully triage older patients as their chief complaints can be non-specific. In particular, when older patients visit the emergency department and exhibit symptoms such as dizziness, abnormal pain, chest discomfort, palpitations, and head trauma, they are more likely to be admitted to the intensive care unit. Therefore, meticulous care for older patients showing these symptoms is essential.

Emergency triage nurses' perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study

BACKGROUND

Triage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome.

OBJECTIVE

To describe triage nurses' perceptions on caring behaviors and patient safety in the triage area.

DESIGN

Strauss and Corbin's Grounded theory method was used to develop the model.

METHODS

The study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin's coding framework.

RESULTS

The analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category "Triage caring", four subcategories were developed: (1) Assurance of triage nurses' presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety.

CONCLUSIONS

The triage nurses' perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient's safety at the same time.

IMPLICATIONS FOR THE NURSING FIELD

A better understanding of the importance of triage nurses' caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients' needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety.

NO PATIENT OR PUBLIC CONTRIBUTION

The study's design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.

Reliability and validity of Chengdu pediatric emergency triage criteria: case study of a single center in China

BACKGROUND

We aimed to examine the reliability and validity of Chengdu pediatric emergency triage criteria in order to provide a reference for the development of pediatric emergency triage within other hospitals.

METHODS

We developed Chengdu pediatric emergency triage criteria based on the conditions/symptom, vital signs, and the Pediatric Early Warning Score system within our hospital using the Delphi method in 2020. The simulation scenario triage and real-life triage which were conducted in our hospital during January - March 2021, and the retrospective study of triage records extracted from our hospital's health information system in February 2022, were used to measure the agreement in triage decisions between the triage nurses, and between the triage nurses and the expert team.

RESULTS

For the 20 simulation cases, the Kappa value of triage decisions between the triage nurses was 0.6 (95% CI 0.352-0.849), and the Kappa value of triage decisions between the triage nurses and the expert team was 0.73 (95% CI 0.540-0.911). For the 252 cases in the real-life triage, the Kappa value of triage decisions between the triage nurses and the expert team was 0.824 (95% CI 0.680-0.962). For the 20,540 cases selected for the retrospective study of triage records, the Kappa value of triage decisions between the triage nurses was 0.702 (95% CI 0.691-0.713); that between Triage Nurse 1 and the expert team was 0.634 (95% CI 0.623-0.647); and that between Triage Nurse 2 and the expert team was 0.725 (95% CI 0.713-0.736). The overall agreement rate in triage decisions between the triage nurses and the expert team in the simulation scenario triage was 80%; that between the triage nurses and the expert team in the real-life triage was 97.6%; and that between the triage nurses in the retrospective study was 91.9%. In the retrospective study, the agreement rates in triage decisions between Triage Nurse 1 and the expert team, and between Triage Nurse 2 and the expert team, were 88.0% and 92.3%, respectively.

CONCLUSION

Chengdu pediatric emergency triage criteria that developed within our hospital is reliable and valid, and can promote rapid and effective triage by triage nurses.

The Priorities of End Users of Emergency Department Electronic Health Records: Modified Delphi Study

BACKGROUND

The needs of the emergency department (ED) pose unique challenges to modern electronic health record (EHR) systems. A diverse case load of high-acuity, high-complexity presentations, and ambulatory patients, all requiring multiple transitions of care, creates a rich environment through which to critically examine EHRs.

OBJECTIVE

This investigation aims to capture and analyze the perspective of end users of EHR about the strengths, limitations, and future priorities for EHR in the setting of the ED.

METHODS

In the first phase of this investigation, a literature search was conducted to identify 5 key usage categories of ED EHRs. Using key usage categories in the first phase, a modified Delphi study was conducted with a group of 12 panelists with expertise in both emergency medicine and health informatics. Across 3 rounds of surveys, panelists generated and refined a list of strengths, limitations, and key priorities.

RESULTS

The findings from this investigation highlighted the preference of panelists for features maximizing functionality of basic clinical features relative to features of disruptive innovation.

CONCLUSIONS

By capturing the perspectives of end users in the ED, this investigation highlights areas for the improvement or development of future EHRs in acute care settings.

Accuracy of nurses’ performance in triage using the emergency severity index and its relationship with clinical outcome measures

Emergency department (ED) triage in hospitals is part of their emergency structure carried out by nurses in emergency units. There have not been many studies available on nurses' performance in triage based on the emergency severity index (ESI). This present study aimed to investigate the nurses’ performance in triage with regard to the emergency severity index and its relation to clinical outcome measures in the emergency department. This was a cross-sectional study. The hospitalization record of 600 patients who arrived at the emergency department of Sanandaj Social Security Hospital was randomly assessed based on the accuracy of triage performed by nurses. The data analysis procedure was done by employing STATA software version 12, as well as Fisher's exact test, independent t-test, and one-way ANOVA. Findings of the study revealed that nurses’ overall performance in triage showed that 82.67% of nurses had perfect triage accuracy, 12.17% had low-level triage accuracy and 5.17% had high-level triage accuracy. There was an association between nurses' performance in triage with the disposition of patients (p=0.029) and length of stay (p=0.009). Results of the study highlighted the importance of theoretical and practical triage training courses for nurses and provided a foundation for identifying effective factors for decreasing the length of stay and disposition of patients in emergency care units.

Association between triage nurses' job satisfaction and professional capability: Results of a mixed-method study

AIM

This study aims to examine factors related to the job satisfaction of triaging nurses and their professional capability in the clinical setting.

BACKGROUND

Triage is a complex process that relies on making decisions in favour of the patient and his treatment. The professional capability of a triaging nurse is an important psychological construct of job satisfaction.

METHODS

The study used a mixed-method methodology, with data collection based on an explanatory research design. The research instrument in the quantitative part was a survey questionnaire, and in the qualitative part, a semi-structured interview. The results were integrated using the 'Pillar Integration Process'.

RESULTS

There are significant relationships between professional capability and job satisfaction. Six main topics were exposed: characteristics and traits, work organization, safety is the key, burdening circumstances, capability and self-evaluation.

CONCLUSION

Professional capability is associated with job satisfaction. The necessary managerial changes should be made to achieve job satisfaction and develop professional competence while focusing on already trained and competent triage nurses, as satisfied triage nurses will stay longer in the institution.

IMPLICATIONS FOR NURSING MANAGEMENT

The manager's job is to be aware of the level of job satisfaction, take care to develop their employee's professional capability and take action in case of disrupted balance.

Facilitators and Barriers of the Triage Process based on Emergency Nurses' Experience with the Korean Triage and Acuity Scale (KTAS): A Qualitative Content Analysis

PURPOSE

Since 2016, the Korean Triage and Acuity Scale (KTAS) algorithm has been applied to the triage process in the emergency departments (EDs) of Korea. This study aimed to investigate the facilitators of and barriers to a well-run triage function based on how Korean emergency nurses perceived the triage process and their experiences with it.

METHODS

Data were collected using focus group interviews from June 2018 to January 2019. Twenty emergency nurses were divided into 2 junior and 4 senior groups based on their level of clinical experience. All interviews were recorded as they were spoken and transcribed. Data were analyzed using qualitative content analysis.

RESULTS

The participants recognized the need for the KTAS algorithm to efficiently classify emergency patients, and were working on it properly. According to the data, we extracted 4 themes and 20 sub-themes. Four themes were as follows; (1) awareness about the necessity of triage, (2) facilitators to triage process, (3) barriers to triage process, and (4) suggestions for the establishment and development of triage.

CONCLUSIONS

From the findings of this study, various vulnerabilities of the triage process were identified, and solutions were suggested from the emergency nurses' perspective. Educational, staffing, financial support, and periodic updates of the KTAS are needed to promote the triage process in the future.

Triage Accuracy and Its Association with Patient Factors Using Emergency Severity Index: Findings from United Arab Emirates

Introduction

The Ministry of Health and Prevention of the UAE acquired an electronic medical record system (Wareed) through which they incorporated the Emergency Severity Index as the standard triaging tool. This raised the need to review population dynamics and the accuracy of triage performed by the health-care providers utilizing the tool.

Objective

This research aimed to study demographics and dynamics of the population presenting to emergency departments (EDs) during 2018, evaluate the accuracy of triage assessment using comparative analysis techniques, and determine relationships between patient factors (severity of illness, age-group) and the accuracy of triage.

Methods

This was an observational study that aimed to ascertain findings from ED data over 1 year (January 2018-December 2018) and explore factors associated with reduced accuracy in acuity assignment. We employed comparative analysis to measure the level of agreement between standard guidelines and local findings.

Results

A total of 576,154 patients visited EDs in 2018, of which 54.4% were male. A statistically significant increase in length of stay with increasing severity of illness was observed (Kruskal-Wallis test). Overall triage accuracy was 41.6%, with a positive association with increasing severity of illness. We found a positive association between severity of illness and accuracy of triage (OR 0.14, p=0). We also found on logistic regression that the age-group 11-20 years had the highest probability of accurate triage acuity (R ²=0.41, p=0).

Conclusion

Conducted on a very large data set from the UAE, our study reflects upon population dynamics and triage accuracy distribution among different variables. This study paves the way for further in-depth analysis of factors that may impact triage accuracy within EDs, and utilizing a similar approach it can be replicated in other settings as well.

Machine learning-based models to support decision-making in emergency department triage for patients with suspected cardiovascular disease

BACKGROUND

Accurate differentiation and prioritization in emergency department (ED) triage is important to identify high-risk patients and to efficiently allocate of finite resources. Using data available from patients with suspected cardiovascular disease presenting at ED triage, this study aimed to train and compare the performance of four common machine learning models to assist in decision making of triage levels.

METHODS

This cross-sectional study in the second Affiliated Hospital of Guangzhou Medical University was conducted from August 2015 to December 2018 inclusive. Demographic information, vital signs, blood glucose, and other available triage scores were collected. Four machine learning models - multinomial logistic regression (multinomial LR), eXtreme gradient boosting (XGBoost), random forest (RF) and gradient-boosted decision tree (GBDT) - were compared. For each model, 80 % of the data set was used for training and 20 % was used to test the models. The area under the receiver operating characteristic curve (AUC), accuracy and macro- F₁ were calculated for each model.

RESULTS

In 17,661 patients presenting with suspected cardiovascular disease, the distribution of triage of level 1, level 2, level 3 and level 4 were 1.3 %, 18.6 %, 76.5 %, and 3.6 % respectively. The AUCs were: XGBoost (0.937), GBDT (0.921), RF (0.919) and multinomial LR (0.908). Based on feature importance generated by XGBoost, blood pressure, pulse rate, oxygen saturation, and age were the most significant variables for making decisions at triage.

CONCLUSION

Four machine learning models had good discriminative ability of triage. XGBoost demonstrated a slight advantage over other models. These models could be used for differential triage of low-risk patients and high-risk patients as a strategy to improve efficiency and allocation of finite resources.

A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa

INTRODUCTION

triage is gradually becoming an autonomous nursing role essential to patients' safety and the efficient delivery of emergency care. The increased need for more holistic and advanced care during triage makes the role of nurses during triage highly indispensable. However, several studies have shown that nurse-led triage has been so successful over the years in most African countries and in other developing countries. South African Triage Scale (SATS) is an example of triage tool that was designed in such a way that the lowest cadre nurse can successfully implement. The success recorded by this tool made most African countries and some other developing countries adopt the tool. The study was designed to explore the roles of nurses during triage in a selected public hospital in KwaZulu-Natal province.

METHODS

this study utilized a quantitative approach, in which a non-experimental survey involving convenience sampling technique was chosen as the most suitable sampling technique for the study. Recognition-primed decision model formed the framework of the study. Ethical clearance was obtained from University of KwaZulu-Natal Ethics Review Board and ethics principles were observed during the study.

RESULTS

the result of the study indicated that majority (100%) of the respondents perceived that nurses have lots of roles to perform during triage. They further unveiled that it is highly paramount for nurses to manage the waiting room and control overcrowding in the unit.

CONCLUSION

the study draws on the need for qualified and experienced nurses to be in charge of these roles in order to reduce the mortality and morbidity rates that usually occur during triage administration.

Comparison of pre-hospital triage training by role playing and lecture on nursing students' knowledge, attitude and performance

Aim

The objective of this study was to determine and compare the effectiveness of two methods of role playing and lecture on knowledge, attitude and performance of nursing' students in the context of pre-hospital triage.

Design

This was a pre-test-posttest quasi-experimental study.

Methods

A total of 66 nursing students (third year) were assigned to two groups, the control group (N = 23) and intervention group (N = 23). START pre-hospital triage was taught to two groups by using a lecture (control group) and role playing (intervention group) method. Immediately before the intervention and 4 weeks after the training, students' knowledge, attitude and practice in both groups were assessed through a questionnaire and a checklist. Data were analysed using SPSS software version 21.

Results

The results showed that the mean scores of knowledge, attitude and performance increased after intervention in both groups (p < .05). The mean (SD) difference of total performance score from baseline to follow-up in the experimental group and the control group was 23.91 (13.83) and 7.00 (13.20), respectively (p < .001). While there was no significant difference between the mean (SD) difference of knowledge and attitude scores in the experimental group and the control group before and after the intervention (p > .05).

Guiding patients to appropriate care: developing Japanese outpatient triage nurse competencies

Japanese patients often seek hospital services without a primary provider’s referral. A triage nurse who is the initial point of contact for a patient is challenged with the task of expertly evaluating the urgency of the condition and selecting the appropriate specialty service for every patient’s needs. A triage nurse must also recognize any conditions requiring emergency medical services instead of a specialty outpatient service. A modified Delphi method was used to establish expert consensus regarding triage nursing competencies for secondary and higher-level health care facilities in Japan.

The initial Delphi round was completed using a questionnaire of 80 competencies that were evaluated by 85 Japanese nurse experts with in-depth knowledge of triage and/or the current Japanese hospital system. Four additional competency items were added based on the experts’ suggestions for a total of 84 items. The experts rated these items on a 7-point Likert scale based on importance. Minimal attrition rate yielded consistent and rich results.

The results were analyzed to identify items rated as very important by the majority. Twenty-two items were included in the final list of competencies. The authors then refined the language and reorganized the items into four proposed domains. The proposed domains and the refined list of competencies provide a foundation for the development of training programs for outpatient triage nurses in the current Japanese health care system.

Nurses' Knowledge and Skills to Manage Patients with Psychological Distress in Emergency Departments

Background:

Identifying and managing patients with psychological distress is a challenge to nurses at emergency departments at hospitals not specialized in psychiatric mental health. This requires that nurses must be equipped with knowledge and skills to fulfill patients’ needs.

Objectives:

The purpose of this study is to identify the knowledge and skills of nurses to manage patients with psychological distress in emergency departments.

Methods:

A convenience sample of 307 registered nurses working at emergency departments completed and returned a package of surveys regarding knowledge and skills to manage patients with psychological distress in emergency departments.

Results:

Although nurses were found to have a high level of knowledge about managing psychological distress, their level of skills was lower. Nurses were found to encounter difficulty in identifying signs and symptoms of patients with psychological distress at emergency departments. A significant and positive correlation was found between nurses’ knowledge and skills (r =.68, p < .001). Statistical and significant differences were found in the knowledge of nursesin relation to their previous experience of receiving training and courses in managing psychological distress (p < .05).

Conclusion:

Nurses need to improve the level of knowledge in order toidentify the psychological and physical signs and symptoms of psychological distress, as well as to be equipped with skills that make them capable tof providing proper care and meeting patients’ needs with psychological distress at emergency departments.

Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review

AIM

To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice.

BACKGROUND

Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined.

DESIGN

Systematic literature review.

DATABASES AND DATA TREATMENT

A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review.

RESULTS

Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied.

CONCLUSION

Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.

Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

BACKGROUND

It is not clear whether Emergency Severity Index (ESI) is valid to triage heart failure (HF) patients and if HF patients benefit more from a customized triage scale or not. The aim of study is to compare the effect of Heart Failure Triage Scale (HFTS) and ESI on mistriage among patients with HF who present to the emergency department (ED).

METHODS

A randomized clinical trial was conducted from April to June 2017. HF patients with dyspnea were randomly assigned to HFTS or ESI groups. Triage level, used resources and time to electrocardiogram (ECG) were compared between both groups among HF patients who were admitted to coronary care unit (CCU), cardiac unit (CU) and discharged patients from the ED. Content validity was examined using Kappa designating agreement on relevance (K*). Reliability of both scale was evaluated using inter-observer agreement (Kappa).

RESULTS

Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively. Time to ECG in HFTS group was significantly shorter than that of ESI group (2.05 vs. 16.82 minutes). Triage level between HFTS and ESI groups was significantly different among patients admitted to CCU (1.0 vs. 2.8), cardiac unit (2.26 vs. 3.06) and discharged patients from the ED (3.53 vs. 2.86). Used resources in HFTS group was significantly different among triage levels (H=25.89; df=3; P<0.001).

CONCLUSION

HFTS is associated with less mistriage than ESI for triaging HF patients. It is recommended to make use of HFTS to triage HF patients in the ED.

Development and validation of the Heidelberg Neurological Triage System (HEINTS)

BACKGROUND/OBJECTIVE

Neurological syndromes are underrepresented in existing triage systems which are not validated for neurological patients; therefore, we developed and validated the new Heidelberg Neurological Triage System (HEINTS) in a prospective, single-center observational study.

METHODS

Patients were triaged according to the new triage system by nurses and physicians (stage 1) as well as trained nurses (stage 2). In stage 1, all patients presenting to the neurological emergency room (ER) were triaged by nurses and physicians. In stage 2, three specially trained nurses triaged patients according to HEINTS. The main outcomes comprised interrater agreement between nurses' and physicians' triage (stage 1), sensitivity and specificity to detect emergencies (stages 1 and 2), and improvement in triage quality as a result of training (stage 2), as well as correlation of HEINTS with hospital admissions and resource utilization.

RESULTS

In stage 1 (n = 2423 patients), sensitivity and specificity to detect neurological emergencies were 84.2% (SD 0.8%) and 85.4% (SD 0.8%) for nurses, as well as 92.4% (SD 0.6%) and 84.1% (SD 0.9%) for physicians, respectively. The interrater-reliability between nurses and physicians in stage 1 was moderate [Cohen's kappa 0.44, standard deviation (SD) 0.02]. In stage 2 (n = 506 patients), sensitivity of trained nurses increased to 94.3% (SD 1.0%), while specificity decreased to 74.8% (SD 1.9%). Correlation of HEINTS triage with hospital admission and resource utilization in both stages was highly significant.

CONCLUSIONS

HEINTS predicted hospital admissions and resource utilization. Agreement between nurses and physicians was moderate. HEINTS, applied by physicians and by nurses after training, reliably detected neurological emergencies.

Troponin Testing in the Emergency Department: Real world experience

Objectives

The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay (LOS).

Methods

This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded.

Results

A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results (81.3%). Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests (mean: three versus one day; P = 0.001). In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome (ACS), atrial fibrillation or other types of arrhythmia.

Conclusion

A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected.

The reliability of the Manchester Triage System (MTS): a meta-analysis

OBJECTIVE

Although the Manchester Triage System (MTS) was first developed two decades ago, the reliability of the MTS has not been questioned through comparison with a moderating variable; therefore, the aim of this study is to determine the extent of the reliability of MTS using a meta-analytic review.

METHOD

Electronic databases were searched up to 1 March 2014. Studies were only included if they had reported sample sizes, reliability coefficients, and adequate description of the reliability assessment. The Guidelines for Reporting Reliability and Agreement Studies was used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was performed based on the method-of-moments estimator.

RESULTS

Seven studies were included. The pooled coefficient for the MTS was substantial at 0.751 (CI 95%: 0.677 to 0.810); the incidence of mistriage is greater than 50%. Agreement is higher for the latest version of MTS (for adults) among nurse-experts and in countries in closer proximity to the country of MTS origin (the UK, in Manchester) than for the oldest (pediatric) version, nurse-nurse raters, and countries at a greater distance from the UK.

CONCLUSION

The MTS showed an acceptable level of overall reliability in the emergency department, but more development is required to attain almost perfect agreement.

The Development of Criteria for the Selection of Chinese Peer Educators in HIV Management: A Delphi Study

To develop an expert consensus opinion of the criteria for selection of peer educator for HIV/AIDS care program, twenty experts were invited to complete a two-round Delphi consultation. Response rates of the panelists for the first and second rounds were both 100%, and the authority coefficient of the experts was 0.75. Experts achieved consensus on a total of nine items (75%) on completion of the study. The Precedence Chart Method was used to calculate the weight of each indicator, and then a priority list was generated accordingly. This study provides the initial selection criteria for HIV/AIDS peer educators in Shanghai as well as in China.