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Analysis of Triage Application in Emergency Department  [PDF]
Ali Kemal Erenler, ?nan? ?zel, Yasemin Ece, Mine Karabulut, Aysun Oru?o?lu, E?ref ?ift?i
Open Journal of Emergency Medicine (OJEM) , 2015, DOI: 10.4236/ojem.2015.33003
Abstract: Objectives: In this study, we aimed to determine the current status of Green Zone (GZ) application in our Emergency Department (ED). We also sought workload and economic burden of GZ on both healthcare providers and health system. Methods: We analyzed the medical data of patients admitted to the GZ of our ED in a three-year period. Demographical characteristics, complaints on admission, number of revisits and economical cost of the patients were determined. Results: During 3-year period a total of ~900,000 patients were admitted to Hitit University Corum Education and Research Hospital ED. Of these patients, 87,089 patients were treated in GZ. Upper respiratory system disease was the leading complaint on admission. Mean length of stay in ED for these patients was found to be 22.2 minutes. When repeated visits were investigated, it was found that 3029 patients presented twice to the GZ. Conclusion: Certain measures to reduce number of non-emergent patients presenting to ED must be taken immediately. Or else, dissatisfaction of both healthcare providers and patients shall remain as a potential cause of unwanted events in over-crowded EDs in the future.
Chest pain in emergency department: Effectiveness of nursing intervention Triage  [PDF]
Sánchez Bermejo R.,Fernández Cantero F.,Rincón Fraile B.,Pe?a Cuevas S.
Páginasenferurg.com , 2011,
Abstract: Prevalence of chest pain in the emergency departmentis 5-20% of visits. The diagnostic possibilities are numerousand range from trivial to emergency health conditions thatare time dependent, hence the need to perform anadequate priority at the time of triage.Objective: To evaluate the effectiveness of nursingintervention in triage in the emergency department (NIC6364) in patients with chest pain.Descriptive study conducted in the emergencydepartment of the Hospital Nuestra Se ora del Prado fromDecember 2008 until June 2009.1030 patients were included. It has been observed thatthe prevalence of chest pain and its characteristics is similarto that reported in other studies. We found that thediagnostic approach to the assessment made of the patient'smedical triage unstructured approaches the final diagnosisat discharge from it. It has been shown that testing timesare improved with respect to internationally establishedquality indicators.
Emergency Department Triage Scales and Their Components: A Systematic Review of the Scientific Evidence
Nasim Farrohknia, Maaret Castrén, Anna Ehrenberg, Lars Lind, Sven Oredsson, H?kan Jonsson, Kjell Asplund, Katarina E G?ransson
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-42
Abstract: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED?2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)?3. How valid is each triage scale in predicting hospitalization and hospital mortality?A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted.We found ED triage scales to be supported, at best, by limited and often insufficient evidence.The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).Triage is a central task in an emergency department (ED). In this context, triage is viewed as the rating of patients' clinical urgency [1]. Rating is necessary to ident
The effectiveness of the South African Triage Score (SATS) in a rural emergency department
K Rosedale, ZA Smith, H Davies, D Wood
South African Medical Journal , 2011,
Abstract: Background. The Modified Early Warning Score (MEWS) is used to monitor medical inpatients in hospitals in the developed world. The South African Triage Score (SATS) was developed from the MEWS, and its use throughout South Africa has been proposed. Objectives. We aimed to assess the effectiveness of the SATS in an emergency department (ED) in a rural setting in KwaZulu-Natal (KZN). Methods. A prospective cross-sectional study undertaken over a 1-month period in June 2009 of patients in the ED of a government hospital in rural KZN, the referral centre for 22 peripheral hospitals. Data capture included physiological parameters, mobility and trauma scores, a list of selected clinical conditions (physician discriminator list), MEWS and SATS scores, final clinical diagnosis, and outcome in the ED (death, hospital admission or discharge). Outcome measures were under- and over-triage rates according to both systems. Results. Over the study period, 589 patients were triaged and their data analysed. The MEWS under-triaged 15.1% (over-triaged 8.3%) of cases that needed admission, compared with an undertriage rate of 4.4% (over-triage rate 4.3%) when the SATS was used. Conclusion. Our study supports use of the SATS as a primary triage score in South African urban and rural hospitals. The SATS is superior to the MEWS as a triage scoring system in a rural hospital ED in KZN, its rates of under- and over-triage falling within the limits of the American College of Surgeons Committee on Trauma (ACSCOT) guidelines.
Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study  [cached]
Yu Jiun-Hao,Weng Yi-Ming,Chen Kuan-Fu,Chen Shou-Yen
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-262
Abstract: Background To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning. Methods Poisoning patients who admitted to our emergency department during the study period were enrolled. Patient’s demographic data were collected and odds ratios (OR) of triage vital signs to in-hospital mortality were assessed. Receiver operating characteristic curve was used to determine the proper cut-off value of vital signs that predict in-hospital mortality. Logistic regression analysis was performed to test the association of in-hospital mortality and vital signs after adjusting for different variables. Results 997 acute poisoning patients were enrolled, with 70 fatal cases (6.7%). A J-shaped relationship was found between triage vital signs and in-hospital mortality. ED triage vital signs exceed cut-off values independently predict in-hospital mortality after adjusting for variables were as follow: body temperature <36 or >37°C, p < 0.01, OR = 2.8; systolic blood pressure <100 or >150 mmHg, p < 0.01, OR: 2.5; heart rate <35 or >120 bpm, p < 0.01, OR: 3.1; respiratory rate <16 or >20 per minute, p = 0.38, OR: 1.4. Conclusions Triage vital signs could predict in-hospital mortality among ED patients with acute poisoning. A J-curve relationship was found between triage vital signs and in-hospital mortality. ED physicians should take note of the extreme initial vital signs in these patients.
Swedish emergency department triage and interventions for improved patient flows: a national update
Nasim Farrokhnia, Katarina E G?ransson
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2011, DOI: 10.1186/1757-7241-19-72
Abstract: In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74) Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows.Nearly all (97%) EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%). Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59%) of the EDs have implemented or plan to implement nurse requested X-ray.There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.When patients can not been seen by a doctor immediately upon arrival to the emergency department (ED), some sort of order for treatment is needed. ED triage, developed since the mid 1900's [1], is nowadays a universal approach for handling such queues [2-4]. Triage is often carried out by registered nurses (RNs) using a triage scale to guide their decision in allocating an acuity level. The development of ED triage varies across the world; Australia being one of the first countries to introduce a five level triage scale, the National Triage Scale (NTS), later renamed the Australasian Triage Scale (ATS) [5]. Anglo-Saxon countries have dominated the development of triage scales, and internationally commonly used scales are the Canadian Emergency Department Triage and Acuity Scale (CTAS), the Manchester Triage Scale (MTS) from the UK and the Emergenc
The use of a new automatic device for patients' assessment at Triage in Emergency Department
Chiara Serena Gori,Benedetta De Bernardinis,Daniele Salvatori,Daniele De Nuzzo
Emergency Care Journal , 2010, DOI: 10.4081/ecj.2010.2.36
Abstract: Objectives: To assess time saving in an Emergency Department arising out of the introduction of automatic devices (Carescape V100) to measure vital signs compared to the manual devices. Methods: We performed a prospective, observational study of eligible patients referring to Sant’Andrea Hospital Emergency Department during the entire month of October 2009, randomly assigned into two groups. In the first group of 476 patients vital signs measurements were detected with manual devices, while in the second group of 477 patients with automatic device Carescape V100. Results: Data indicated that the comparison of the total time between the two groups gave a significant difference (1993 vs 1518 min, p < 0.001). No differences were found with respect to age, sex and priority codes. Significant differences were also found when comparing the subgroups of the same acuity categories: white codes 4.33 vs 2.27 (min), p < 0.05; green codes 4.28 vs 3.37 (min), p < 0.001; yellow codes 3.92 vs 2.72 (min), p < 0.001. Conclusions: Our data demonstrated a statistical significance between the two groups with a difference of 475 minutes spent in Triage procedures including vital signs measurements. In conclusion time saved by vital signs automatic device could allow ED physicians to make a qualified approach with an earlier diagnosis and a more rapid and effective therapy, possibly improving patients’ outcomes. ABSTRACT of data concerning vital signs quality assessment, because we did not compare the two methods in the same patient and we did not correlate Triage priority evaluation with patients’ outcomes. In the future further studies should be specifically aimed to address this issue. In conclusion time saved by vital signs automatic device could allow ED physicians to make a qualified approach to patient with an earlier diagnosis and a more rapid and effective therapy, possibly improving patients’ outcomes.
Evaluation of Nurse-Physician Inter-Observer Agreement on Triage Categorization in the Emergency Department of a Taiwan Medical Center  [PDF]
Song-Seng Loke,Shiumn-Jen Liaw,Lee Keong Tiong,Tiing-Soon Ling
Chang Gung Medical Journal , 2002,
Abstract: Background: To examine nurse-physician inter-observer agreement on triage categorizationand analyze their differences for future reference.Methods: A retrospective observational study was performed. Patients entering a3500-bed medical center emergency department (ED) from July 1 to 31,1998 were randomly selected. We compared triage assignments made bynurses and 2 ED physicians, and examined them for inter-observer agreement(kappa-statistic) within each illness category.Results: We found that the overall nurse-physician agreement on triage categorizationhad a £e-value of 0.32 (99% confidence interval, 0.27-0.37). The level ofinter-observer agreement was not consistent across all illness categories.Agreement was better when assigning critical patients, but it was poor whenassigning non-emergency patients.Conclusion: The overall nurse-physician agreement with triage categorization was poor.The lack of agreement on triage decision making has important implicationsfor EDs in which the priority of care is based on nursing triage categorization.Detailed chart recording and continued work is necessary to improvethe agreement between nurse-physician triage categorization.
Impact of the ABCDE triage on the number of patient visits to the emergency department
Jarmo Kantonen, Johanna Kaartinen, Juho Mattila, Ricardo Menezes, Mia Malmila, Maaret Castren, Timo Kauppila
BMC Emergency Medicine , 2010, DOI: 10.1186/1471-227x-10-12
Abstract: A face-to-face triage system based on the letters A (patient directly to secondary care), B (to be examined within 10 min), C (to be examined within 1 h), D (to be examined within 2 h) and E (no need for immediate treatment) for assessing the urgency of patients' treatment needs was applied in the main ED in the City of Vantaa, Finland (Peijas Hospital) as an attempt to provide immediate treatment for the most acute patients. The first step was an initial patient assessment by a health care professional (triage nurse). If the patient was not considered to be in need of immediate care (i.e. A-D) he was allocated to group E and examined after the more urgent patients were treated. The introduction of this triage system was combined with information to the public on the "correct" use of emergency services. The primary aim of this study was to assess whether the flow of patients was changed by implementing the ABCDE-triage system in the combined ED. To study the effect of the intervention on patient flow, numbers monthly visits to doctors were recorded before and after intervention in Peijas ED and, simultaneously, in control EDs (Myyrm?ki in Vantaa, Jorvi and Puolarmets? in Espoo). To study does the implementation of the triage system redirect patients to other health services, numbers of monthly visits to doctors were also scored in the private health care and public office hour services of Vantaa primary care.The number of patient visits to a primary care doctor in 2004 decreased by up to eight percent (340 visits/month) as compared to the previous year in the Peijas ED after implementation of the ABCDE-triage system. Simultaneously, doctor visits in tertiary health care ED increased by ten percent (125 visits/month). ABCDE-triage was not associated with a subsequent increase in the number of patient visits in the private health care or office hour services. The number of ED visits in the City of Espoo, used as a control where no triage was applied, remained unchange
A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure  [PDF]
Michael K. Howlett,Paul R. T. Atkinson
Emergency Medicine International , 2012, DOI: 10.1155/2012/636045
Abstract: Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED) workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS) performance. Methods. A trained nurse reviewer (NR) retrospectively triaged two separate month’s ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604). Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts. 1. Introduction Accurate assessment of triage (a French term meaning “to sort”) processes and outcomes is central to any research on emergency department (ED) crowding. Patient volumes and acuity, the aging population, public demands for advanced technology, evidence-based medicine, and payor austerity measures increase pressure on emergency department processes. With increasing demand on EDs and increasing crowding issues, studies must examine factors that influence patient flow. These studies depend on accurate measurements of disease severity and workload. Triage data are used extensively as a proxy for both workload and patient acuity. Thus proper conduct of research into crowding and the ability to apply results across facilities depends on accuracy and reliability of the data. The five-level Canadian Triage and Acuity Scale (CTAS), using a standardized data element set including a validated Chief Complaint list, has been adopted by the Canadian Association of Emergency Physicians (CAEPs) and National Emergency Nurses Affiliation (NENA) as the standard methodology for emergency department triage [1–3]. Similar five-level systems are used in the United States, the United Kingdom, and Australia as well as in other jurisdictions. The Canadian Triage and Acuity Scale (CTAS) has been used not only for
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