To see the other types of publications on this topic, follow the link: Emergency triage.
Journal articles on the topic 'Emergency triage'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Emergency triage.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Kumar, R., S. Bhoi, S. Chauhan, T. P. Sinha, G. Adhikari, G. Sharma, and K. Shyamla. "(A264) Does the Implementation of Start Triage Criteria in the Emergency Department Reduce Over- and under-Triage of Patients?" Prehospital and Disaster Medicine 26, S1 (May 2011): s72—s73. http://dx.doi.org/10.1017/s1049023x11002482.
Full textAbstract:
BackgroundAppropriate triage shortens the delay in definitive care. this study examined whether the implementation of START triage criteria in emergency departments (ED) reduces over- and under-triage of patients. The purpose of this study was to examine the impact of START triage criteria on over and under-triage subjects.MethodsThe study was performed between 01 January to 15 September 2008. All patients presenting to the ED were recruited. A triage nurse tagged the patients with a red, yellow, and or green wristband, as per START triage protocol. Over-triage was defined as patients who were re-triaged from red (R) to yellow (Y) or Y to green (G) within 30 minutes of arrival. Under-triage was defined as patients re-triaged from Y to R or G to Y within 30 minutes of arrival.ResultsOf 25,928 patients, triage was performed for 25,468 (98.2%) subjects. A total of 8,303 were triaged during the morning shift, 6,994 during the evening shift, and 9,978 during the night shift. A total of 1,431 (5.6%) subjects were tagged as R, 10,634 (41.7%) with Y, and 13,424 (52.7%) were tagged as G. Four hundred seventy-four (1.9%) patients were over-triaged. Two hundred twenty (0.9%) were under-triaged.ConclusionsThe START triage criteria reduce over- and under-triage of patients.
2
Styrwoldt, E. "(P1-37) Over and Undertriage in Simulation Exercises." Prehospital and Disaster Medicine 26, S1 (May 2011): s110. http://dx.doi.org/10.1017/s1049023x11003694.
Full textAbstract:
Over and undertriage in simulation exercises Introduction The first healthcare personnel arriving at the scene of an accident or major incident is often an ambulance crew. It is therefore of importance that they are familiar with, and can practice triage during situations were there is a lack of resources. Overtriage, when a casualty is given a priority higher than motivated, may lead to inadequate use of resources, while undertriage can be seen as a risk for medical errors. There is a consensus that up to 50% overtriage is accepted in order to have an undertriage, which is less than 5%. The aim of this study was to increase knowledge regarding prehospital personnel's triage during standardized simulation exercises.Material and Method76 standardized simulation exercises where the triage of casualties was evaluated. The exercises were part of a training program for medical command and control at scene. The students trained were all professional ambulance crew. The scenario was a fire at a football stand with 50 causalities. All in all 3800 (76 x 50) triages were performed. The simulation system used was Emergo Train System. Prior to the exercises an expert group had triaged the causalities according to the MIMMS system (sieve). Of the 50 patients 15 were triaged as T1 by the expert group and the rest were not.ResultsOf the 3800 triages 37% (n = 410) were classified as undertriage and 13% (n = 134) as overtriage. The most frequently undertriage casualties had an airway and/or breathing problem that were not observed. The most frequently overtriage casualties had a burn injury involving 30% of body surface area or unconscious casualties.ConclusionsTriage in this simulation setting did not meet acceptable standards. More triage training for ambulance crew may improve outcome. More studies are needed regarding simulation exercises as a tool for evaluating results of triage.
3
Hilmi, L. M., A. Heerboth, D. Anthony, C. Tedeschi, and S. Balsari. "(A167) Patient Tracking In Disaster Drills." Prehospital and Disaster Medicine 26, S1 (May 2011): s48. http://dx.doi.org/10.1017/s1049023x11001658.
Full textAbstract:
IntroductionDisaster Drills, the world over, test several aspects of disaster response encompassing inter-agency coordination, institutional response and individual proficiency. This abstract analyzes the efficiency and gaps in patient triage in a large inter-agency disaster drill conducted in Mumbai in December 2010.MethodsOver eighty simulated patients at the mock disaster site in Mumbai were triaged for transport to two hospitals via prioritized EMS vehicle and other modalities. Each patient was tagged with an identifier and his/her final destination compared to the intended destination to gauge accuracy of triage. Arrival and departure time-stamps at each location helped plot triage efficiency and variation in inter-group response times. EMS responders were trained in START triage during the preparatory phase.ResultsThere was no significant difference in time to transport “red” and “yellow” patients to the triage zone. Patients in the “accident buses” were triaged twice as slowly as those outside in spite of the zone being declared safe to enter, by the controlling authorities. 11% of “red patients” were down-triaged and 30% of yellows were “over-triaged.” A significant bottle-neck developed between field triage zone and transport zones.ConclusionsOur group has conducted disaster drills in several large cities in Sri Lanka, India and the Dominican Republic. Expanding focus to document time-stamps and triage accuracy highlighted need for more robust triage training, allowing local agencies to prioritize training for EMS responders in the coming months. Demonstrating how inaccurate triage could potentially overwhelm the system helped local agencies recognize the need to train first responders in START triage.
4
Atmojo, Joko Tri, Aris Widiyanto, and Tri Yuniarti. "RELIABILITAS SISTEM TRIASE DALAM PELAYANAN GAWAT DARURAT : A REVIEW." Intan Husada Jurnal Ilmu Keperawatan 7, no. 2 (July 12, 2019): 23–31. http://dx.doi.org/10.52236/ih.v7i2.148.
Full textAbstract:
Pendahuluan.Triase dalam pelayanan gawat darurat adalah proses pengambilan keputusan yang diterapkan untuk mengidentifikasi pasien dan mengoptimalkan sumber daya. Sejak 1990 hingga tahun 2000 telah dirancang triase 5 skala diantaranya: Australian Triage Scale (ATS), Canadian Emergency Department Triage and Acuity Scale (CTAS), Manchester Triage Scale (MTS), dan Emergency Severity Index (ESI). Sehingga timbul pertanyaan tentang keandalan skala triase (reliabilitas). Pada review kali ini penulis akan fokus pada berbagai macam skala triase, penggunaannya di beberapa negara, dan reliabilitasnya. Penulis tidak akan menulis kembali pedoman/guideline dari triase yang telah secara resmi terpublikasikan.
Metode. Penelusuran ini dilakukan mulai dari Januari hingga Maret 2019 dengan melakukan penelusuran database: PubMed, EMBASE, dan CINAHL. Kata kunci yang digunakan: ‘Triage in emergency 'ATAU' Canadian Triage and Acuity Scale’ ATAU ‘Emergency Severity Index’ ATAU ‘Manchester Triage Scale’ ATAU ‘Australasian Triage Scale’. Kriteria inklusi: uji acak terkendali (randomized controlled tria), studi retrospektif, observasional, studi kasus, review, systematc review, dan meta analisis. Hasil akhir review menemukan 12 artikel yang sesuai
Hasil. Uji statistik Kappa menunjukan reliabilitas ATS 0,428 (95% CI 0,340-0,509), reliabilitas CTAS 0,871 (95% CI (0,840-0,897), reliabilitas ESI 0.730 (95% CI : 0.692 hingga 0.767), reliabilitas MTS 0,751 (CI 95%: 0,677 hingga 0,810).
Kesimpulan. Berdasarkan hasil reliabilitas nilai ATS menunjukan realibilitas terkecil, realibilitas CTAS merupakan yang tertinggi, namun memiliki keterbatasan pada pelaksaan diluar Kanada. MTS merupakan skala yang reliabilitas dan juga penerapannya dianggap yang paling baik.
Kata Kuci: Reliabilitas, Canadian Triage and Acuity Scale (CTAAS), Emergency Severity Index (ESI), Manchester Triage Scale (MTS), Australasian Triage Scale (ATS).
5
Khorram- Manesh, A., A. Hedelin, and P. Ortenwall. "(A82) Triage in the Prehospital Setting." Prehospital and Disaster Medicine 26, S1 (May 2011): s23. http://dx.doi.org/10.1017/s1049023x11000872.
Full textAbstract:
IntroductionThe prehospital management of a patient starts with a telephone call to and triage by the ambulance dispatcher centre followed by continuous evaluations by ambulance crews and staff at emergency departments.AimThe aim of this study was to find out if these units have the same triage systems and if the initial evaluation matches the outcome at the hospital emergency departments.Method and MaterialOver 27000 ambulance transports within Gothenburg were studied by evaluating the ambulance medical records with regards to initial triage performed by the ambulance dispatcher centre using a medical index and triage performed by ambulance crews and staff at the emergency departments.ResultsThere was no common triage system between these units. We also found a discrepancy between the initial triage using the medical index and physiological-anatomical triage performed by ambulance crews and staff at the emergency departments. As an example 50% of all patients triaged as priority one by the ambulance dispatcher centre were down-graded to priority 2–4 by the other units involved.Discussion and ConclusionsA mutual and standardized system for triage is needed. Although over-triaged by ambulance dispatcher centre may be medically motivated, the difference between priorities should be minimized to a medically accepted level (25–35%).
6
Poon, Wai Kwong. "TRIAGE! TRIAGE!! TRIAGE!!! (NOT TREATMENT!!)." Prehospital and Disaster Medicine 14, S1 (March 1999): S96—S97. http://dx.doi.org/10.1017/s1049023x0003497x.
Full text
7
Marsden, Janet, Jill Windle, and Kevin Mackway-Jones. "Emergency triage." Emergency Nurse 21, no. 4 (July 2013): 11. http://dx.doi.org/10.7748/en2013.07.21.4.11.s11.
Full text
8
McCallum Pardey, Toni G. "Emergency Triage." Australasian Emergency Nursing Journal 10, no. 2 (May 2007): 43–45. http://dx.doi.org/10.1016/s1574-6267(07)00054-7.
Full text
9
O'Shea, Roseanne. "Emergency triage." Clinical Effectiveness in Nursing 1, no. 4 (December 1997): 225–26. http://dx.doi.org/10.1016/s1361-9004(97)80013-1.
Full text
10
Sloan, J. "Emergency Triage." Emergency Medicine Journal 14, no. 3 (May 1, 1997): 191. http://dx.doi.org/10.1136/emj.14.3.191-b.
Full text
11
Irawan, Deni, Woro Hapsari, and Yohan Tedy Kurniawan. "EFEK TRIAGE EMERGENCY SEVERITY INDEX (ESI) TERHADAP LENGTH OF STAY DI INSTALASI GAWAT DARURAT RSU ISLAM HARAPAN ANDA KOTA TEGAL." JURNAL PENELITIAN KEPERAWATAN 6, no. 1 (May 11, 2020): 20–27. http://dx.doi.org/10.32660/jpk.v6i1.447.
Full textAbstract:
Kepadatan pasien menjadi masalah serius yang terjadi di unit gawat darurat dan menyebabkan efek negatif dari peningkatan kematian pasien, ketidakpuasan dengan layanan gawat darurat, kelelahan perawat, peningkatan risiko tertular penyakit menular, dan peningkatan lama tinggal. Length of Stay (LOS) berkepanjangan terkait erat dengan kinerja layanan keperawatan dan triase kualitas di ruang gawat darurat. Metode triase rumah sakit saat ini telah berevolusi, sistem triase cepat dan efisien telah terbukti mengurangi kepadatan pasien dan lama tinggal. Emergency Severity Index (ESI) adalah sistem triase yang valid dan akurat dengan mengidentifikasi pasien secara cepat yang membutuhkan perhatian segera. Tujuan dari penelitian ini adalah untuk mengukur "Triage Emergency Severity Index (ESI) Efek pada Durasi Menginap di Departemen Darurat". Penelitian ini adalah penelitian Quasi Eksperimen Desain menggunakan Post Test Only Non-equivalent Control Group Design, teknik purposive sampling. Jumlah sampel dalam penelitian ini adalah 110 responden yang dibagi ke dalam kelompok perlakuan menggunakan triage Emergency Severity Index (ESI) sebanyak 55 responden dan kelompok kontrol menggunakan responden Triage klasik 55. Hasil analisis Uji Mann Whitney, nilai p 0,000 <0,05. Kesimpulan Ada pengaruh penerapan Triage Emergency Severity Index (ESI) terhadap Lama tinggal di ED. Triage Emergency Severity Index sebagai alat untuk menyortir pasien ini lebih efektif digunakan.
12
Cuttance, Glen, Kathryn Dansie, and Tim Rayner. "Paramedic Application of a Triage Sieve: A Paper-Based Exercise." Prehospital and Disaster Medicine 32, no. 1 (December 14, 2016): 3–13. http://dx.doi.org/10.1017/s1049023x16001163.
Full textAbstract:
AbstractIntroductionTriage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area.ObjectiveThe goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates.MethodTwo hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire.ResultsThe study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups.ConclusionThis study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A “just-in-time” educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI.CuttanceG, DansieK, RaynerT. Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3–13.
13
Tavakoli, Nader, Saeed Abbasi, and Afrooz Tayebi. "Concordance of triage performed with emergency severity index in the emergency departments of Rasoul Akram and Haft Tir hospitals." Journal of Preventive Epidemiology 5, no. 1 (October 29, 2020): e11-e11. http://dx.doi.org/10.34172/jpe.2020.11.
Full textAbstract:
Introduction: Triage is prioritizing patients by disease severity in the shortest possible time. Proper triage increases the quality of patient care services, increases patient’s satisfaction, decreases patient waiting time, decreases mortality, and enhances emergency department efficiency. Objectives: The aim of this study was to evaluate the concordance of triage performed by nurses with ESI standard, at Rasoul Akram and Haft Tir hospitals, which are the most important educational centers of Iran University of Medical Sciences. Patients and Methods: This is a cross-sectional design study done in 2019. The study population is patients referred to Rasoul Akram and Haft Tir hospitals. A sample of 800 patients was selected. In this study, we determined how triage level were determined and compared with triaging by emergency medicine assistant. Data were analyzed by SPSS 23. Results: Out of 800 samples, the highest triage level was related to level three (79.1%) and levels two, four and one were in the next levels. 13.5% of the cases were not properly triaged according to the ESI standard and the adaptation coefficient (kappa) between the triage level specified in the patient file with the emergency severity index (ESI) triage level between physician and nurse was 58%, which was a significant difference (P<0.001). The relationship between correct triage leveling and patients’ complaints was significant (P<0.001). Conclusion: Nurses triage education about appropriate triage and ESI tool should be one of the most urgent topics and priorities of the studied hospitals. Over triage causes resources wasted and under triage may harm the patient’s health.
14
Khursheed, M., K. Ejaz, and F. Hanif. "(A261) Evolution of Triage Services in the Emergency Department Aga Khan University Hospital- Karachi." Prehospital and Disaster Medicine 26, S1 (May 2011): s72. http://dx.doi.org/10.1017/s1049023x11002457.
Full textAbstract:
The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.
15
McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO70: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 20, S1 (May 2018): S31—S32. http://dx.doi.org/10.1017/cem.2018.132.
Full textAbstract:
Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, ED funding and workload models. The Electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes the application of national triage guidelines (CTAS) across Ontario. The objective of this study was to evaluate the implementation of eCTAS in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1200 (738 pre-eCTAS, 462 post-implementation) individual patient CTAS assessments were audited over 33 (21 pre-eCTAS, 11 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients pre-eCTAS, compared to 429 (93.0%) patients triaged with eCTAS. Using the auditors CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.1% vs. 3.2%; 8.9, 95% CI: 5.7, 11.7) and under-triaged (12.9% vs. 3.9%; 9.0, 95% CI: 5.9, 12.0). Interrater agreement was higher with eCTAS (unweighted kappa 0.90 vs 0.63; quadratic-weighted kappa 0.79 vs. 0.94). Research assistants captured triage time for 4403 patients pre-eCTAS and 1849 post implementation of eCTAS. Median triage time was 304 seconds pre-eCTAS and 329 seconds with eCTAS ( 25 seconds, 95% CI: 18, 32 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
16
McLeod, S., J. McCarron, T. Ahmed, S. Scott, H. Ovens, N. Mittmann, and B. Borgundvaag. "LO81: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score pre and post implementation of eCTAS." CJEM 21, S1 (May 2019): S37. http://dx.doi.org/10.1017/cem.2019.123.
Full textAbstract:
Introduction: In addition to its clinical utility, the Canadian Triage and Acuity Scale (CTAS) has become an administrative metric used by governments to estimate patient care requirements, emergency department (ED) funding and workload models. The electronic Canadian Triage and Acuity Scale (eCTAS) initiative aims to improve patient safety and quality of care by establishing an electronic triage decision support tool that standardizes that application of national triage guidelines across Ontario. The objective of this study was to evaluate triage times and score agreement in ED settings where eCTAS has been implemented. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 1491 (752 pre-eCTAS, 739 post-implementation) individual patient CTAS assessments were audited over 42 (21 pre-eCTAS, 21 post-implementation) seven-hour triage shifts. Exact modal agreement was achieved for 567 (75.4%) patients pre-eCTAS, compared to 685 (92.7%) patients triaged with eCTAS. Using the auditor's CTAS score as the reference standard, eCTAS significantly reduced the number of patients over-triaged (12.0% vs. 5.1%; Δ 6.9, 95% CI: 4.0, 9.7) and under-triaged (12.6% vs. 2.2%; Δ 10.4, 95% CI: 7.9, 13.2). Interrater agreement was higher with eCTAS (unweighted kappa 0.89 vs 0.63; quadratic-weighted kappa 0.91 vs. 0.71). Research assistants captured triage time for 3808 patients pre-eCTAS and 3489 post implementation of eCTAS. Median triage time was 312 seconds pre-eCTAS and 347 seconds with eCTAS (Δ 35 seconds, 95% CI: 29, 40 seconds). Conclusion: A standardized, electronic approach to performing CTAS assessments improves both clinical decision making and administrative data accuracy without substantially increasing triage time.
17
Marks, Peter, and Tim Daniel. "Emergency Ambulance Triage." Journal of the Royal Society of Medicine 95, no. 5 (May 2002): 270. http://dx.doi.org/10.1177/014107680209500523.
Full text
18
Marks, P., and T. Daniel. "Emergency ambulance triage." JRSM 95, no. 5 (May 1, 2002): 270. http://dx.doi.org/10.1258/jrsm.95.5.270.
Full text
19
O'Callaghan, Maureen, Grainne Gallagher, Danielle Reddy, Lorna Cornally, Megan Hayes Brennan, Ann Mulholland, Ruth Gibbons, Jane Nolan, Cathriona Normoyle, and Emer Ahern. "335 GEMS: Geriatric Emergency Service Emergency Triage and Older People with Frailty." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.218.
Full textAbstract:
Abstract Background The Manchester Triage System (MTS) is one of the most commonly used triage systems in Europe. It assigns a clinical priority to patients, based on presenting signs and symptoms. The MTS allocates patients to one out of five urgency categories, which determine the maximum time to first contact with a clinician. Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) are core elements of our GEMS. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home (Ellis et al 2011). Methods The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are triaged using the Manchester Triage system. Patients are also screened using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team case manage all those who are admitted. Results Over 2 years, 10,037 patients were triaged. The median time from arrival to triage and VIP was 15 minutes. 43% (4, 307) screened positive for Frailty. 66% received a CGA. Of those who screened positive for Frailty 1,387 (32%) needed immediate care or very urgent care (Category 1 and 2). A further 43% (1,855) were category 3 requiring urgent care. The most common diagnostic category was Unwell Adult (1560, 36%). The 2nd category was Shortness of Breath (720, 17%) and the third Falls (409, 9%) Conclusion 75% of older people with frailty who attended hospital required urgent emergency care. The most common diagnostic category was Unwell Adult reflecting the diagnostic and clinical challenge this cohort present. We must build a healthcare system and workforce that is Frailty attuned to be able to deliver optimum outcomes.
20
Alson, R. L. "(A258) Is It S.M.A.R.T. To S.T.A.R.T. To S.A.L.T. M.A.S.S. Casualty Victims?" Prehospital and Disaster Medicine 26, S1 (May 2011): s71. http://dx.doi.org/10.1017/s1049023x11002421.
Full textAbstract:
Triage of disaster and trauma victims is challenging, especially when responders have limited resources and brief periods of time. Over-triage of victims results in the consumption of resources that would be better utilized on more critical patients, and under-triage can result in increased mortality and/or morbidity, as victims do not receive the appropriate care. In addition, the same patient may be triaged multiple times as they move through echelons of care. These different echelons may have different objectives in the triage process Over the years, multiple triage schemes have been proposed and used, both in exercises and real events. None of these schemes is based on well-defined research, due to the difficulty of carrying out a randomized control study in real events. There has been a concerted effort to apply research findings in a effort to more effectively use resources and thus, improve patient outcomes as well as apply information garnered from after action reports. This presentation reviews the current issues and state of triage for disasters and mass-casualty incidents, drawing on examples from prior events. The ultimate objective of this presentation is to help the responder to better understand the process of triage and apply it to their clinical practice, thereby delivering care in an effective and timely manner.
21
Astuti, Zulmah, Misbah Nurjannah, and Dwi Widyastuti. "Studi Fenomenologi:Peran perawat Dalam Penetapan Level Triase." Care : Jurnal Ilmiah Ilmu Kesehatan 6, no. 2 (July 2, 2018): 131. http://dx.doi.org/10.33366/cr.v6i2.887.
Full textAbstract:
Triase adalah proses pengumpulan informasi dari pasien, mengkategorikan dan memprioritaskan kondisi pasien dan merupakan bagian dari upaya manajemen patient safety di rumah sakit khususnya di Instalasi gawat darurat. Model triase yang banyak di gunakan di Dunia termasuk di Indonesia adalah triase lima level yang menempatkan pasien pada lima prioritas yaitu Resucitation, Emergent, Urgent, Nonurgent, Referred. Triase secara otonomi dilakukan oleh perawat yang teregistrasi dan telah mengikuti pelatihan khusus triase. di Indonesia, triase lima level telah digunakan di Rumah sakit umum dan evaluasi terkait pelaksanaannya masih belum banyak terpublikasi. Peran perawat dalam proses triase termasuk hal yang baru dan memerlukan pegkajian lebih mendalam terkait pengalaman perawat terhadap penetapan level triase. Penelitian kuaitatif fenomenologi desktriptif dilakukan pada enam partisipan yang merupakan perawat instalasi gawat darurat yang bekerja di ruang Triase, wawancara mendalam dilakukan dan hasil wawancara di transkrip dan dinalisis menggunakan metode Miles and Huberman (1994). Hasil penelitian didapatkan tiga tema besar yaitu level triase berdasarkan pengkajian primer, perawat belum mandiri, kolaborasi dokter dan perawat. Pelaksanaan triase belum menjadi tindakan mandiri perawat dan merupakan bagian dari tim triase dimana keputusan triase masih bergantung pada dokter. Diperlukan penelitian lebih lanjut terkait efisiensi dan efektifitas pelaksanaan triase oleh perawat di intalasi gawat darurat
Abstract
Triage is the process of collecting information from patients, categorizing and prioritizing the patient's condition and is part of patient safety management efforts in hospitals, especially in emergency departments. The triage model widely used in the World including Indonesia is a five-level triage that places patients on five priorities: Resucitation, Emergent, Urgent, Nonurgent, Referred. Triage is autonomously performed by registered nurses and has attended special triage training. In Indonesia, a triage of five levels has been used in public hospitals and evaluations related to their implementation have not been widely publicized. The role of nurses in the triage process is novel and requires a more in-depth review of nurses' experience of establishing triage levels. A qualitative study of descriptive phenomenology was performed on six participants who were nurses who worked in the Triage room. Research was conducted by conducting in-depth interviews and the results were analyzed using Miles and hubermen (1997). The research results obtained three major themes namely the level of triage based on the primary assessment, nurses have not been independent, collaboration of doctors and nurses. Implementation of triage has not been a self-sustaining act of nurses and is part of the triage team where triage decisions are still dependent on physicians. Further research is needed regarding the efficiency and effectiveness of triage implementation by nurses in emergency department
22
Bielajs, Ingrid, Frederick M. Burkle, Frank L. Archer, and Erin Smith. "Development of Prehospital, Population-Based Triage-Management Protocols for Pandemics." Prehospital and Disaster Medicine 23, no. 5 (October 2008): 420–30. http://dx.doi.org/10.1017/s1049023x00006154.
Full textAbstract:
AbstractThe lack of disease-specific triage-management protocols that address the unique aspects of a pandemic places emergency medical services, and specifically, emergency medical services practitioners, at great risk.Without adequate protocols, the emergency health system will risk needless exposure, loss of functional capacity, and inappropriately triaged patients.This paper reports on the development of population-based triage-management protocols at two patient points of contact. The primary objective of the triage-management protocols is to identify patients infected by or exposed to the biological agent, and consequently, appropriately triage patients so as to optimize the utilization of emergency medical services and surge capacity resources through disposition and care at hospital-and non-hospital-based care facilities. Protocols must include standardized “flu questions”and a Fear and Resiliency Checklist to ensure protection and separation of the susceptible population from those infected or exposed.
23
Betz, Martin, James Stempien, Sachin Trevidi, and Rhonda Bryce. "A determination of emergency department pre-triage times in patients not arriving by ambulance compared to widely used guideline recommendations." CJEM 19, no. 04 (December 5, 2016): 265–70. http://dx.doi.org/10.1017/cem.2016.398.
Full textAbstract:
ABSTRACT Objectives Emergency department (ED) lengths of stay are measured from the time of patient registration or triage. The time that patients wait in line prior to registration and triage has not been well described. We sought to characterize pre-triage wait times and compare them to recommended physician response times, as per the Canadian Triage and Acuity Scale (CTAS). Methods This observational study documented the time that consenting patients entered the ED and the time that they were formally registered and triaged. Participants’ CTAS scores were collected from the electronic record. Patients arriving to the ED by ambulance were excluded. Results A total of 536 participants were timed over 13 separate intervals. Of these, 11 left without being triaged. Participants who scored either CTAS 1 or 2 (n=53) waited a median time of 3.1 (interquartile range [IQR]: 0.43, 11.1) minutes. Patients triaged as CTAS 3 (n=187) waited a median of 11.4 (IQR: 1.6, 24.9) minutes, CTAS 4 (n=139) a median of 16.6 (IQR: 6.0, 29.7) minutes, and CTAS 5 (n=146) a median of 17.5 (IQR: 6.8, 37.3) minutes. Of patients subsequently categorized as CTAS 1 or 2, 20.8% waited longer than the recommended time-to-physician of 15 minutes to be triaged. Conclusions All urban EDs closely follow patients’ wait times, often stratified according to triage category, which are assumed to be time-stamped upon a patient’s arrival in the ED. We note that pre-triage times exceed the CTAS recommended time-to-physician in a possibly significant proportion of patients. EDs should consider documenting times to treatment from the moment of patient arrival rather than registration.
24
Brutschin, Vanessa, Monika Kogej, Sylvia Schacher, Moritz Berger, and Ingo Gräff. "The presentational flow chart “unwell adult” of the Manchester Triage System—Curse or blessing?" PLOS ONE 16, no. 6 (June 3, 2021): e0252730. http://dx.doi.org/10.1371/journal.pone.0252730.
Full textAbstract:
Background The presentational flow chart “unwell adult” of the Manchester Triage System (MTS) occupies a special role in this triage system, defined as the nonspecific presentation of an emergency patient. Current scientific studies show that a considerable proportion of emergency room patients present with so-called "nonspecific complaints". The aim of the present study is to investigate in detail the initial assessment of emergency patients triaged according to the presentational flow chart "unwell adult". Methods Monocentric, retrospective observational study. Results Data on 14,636 emergency department visits between March 12th and August 12th, 2019 were included. During the observation period, the presentational flow chart "unwell adult" was used 1,143 times and it was the third most frequently used presentational flow chart. Patients triaged with this flow chart often had unspecific complaints upon admission to the emergency department. Patients triaged with the “unwell adult” chart were often classified with a lower triage level. Notably, patients who died in hospital during the observation period frequently received low triage levels. The AUC for the MTS flow chart “unwell adult” and hospitalization in general for older patients (age ≥ 65 years) was 0.639 (95% CI 0.578–0.701), and 0.730 (95% CI 0.714–0.746) in patients triaged with more specific charts. The AUC for the MTS flow chart “unwell adult” and admission to ICU for older patients (age ≥65 years) was 0.631 (95% CI 0.547–0.715) and 0.807 (95% CI 0.790–0.824) for patients triaged with more specific flow charts. Comparison of the predictive ability of the MTS for in-hospital mortality in the group triaged with the presentational flow chart “unwell adult” revealed an AUC of 0.682 (95% CI 0.595–0.769) vs. 0.834 (95% CI 0.799–0.869) in the other presentational flow charts. Conclusion The presentational flow chart "unwell adult" is frequently used by triage nurses for initial assessment of patients. Patient characteristics assessed with the presentational flow chart "unwell adult" differ significantly from those assessed with MTS presentational flow charts for more specific symptoms. The quality of the initial assessment in terms of a well-functioning triage priority assessment tool is less accurate than the performance of the MTS described in the literature.
25
McCourt, Jacita A., Eli Strait, and Jeanne Lee. "583 Photos of Burn Wounds Can Help Reduce Over-Triage and Prevent Unnecessary Ambulance Transfer." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S128—S129. http://dx.doi.org/10.1093/jbcr/irac012.211.
Full textAbstract:
Abstract Introduction Burn wounds can be difficult to assess for providers outside the burn center and can result in over triage. The combination of photos of burn wounds with a clinical history can help burn practitioners make appropriate triage decisions, including immediate ambulance transfer vs scheduling an outpatient follow up appointment. Appropriate photo triage can help reduce healthcare costs by eliminating both unnecessary transfers to the burn center and overburdening burn resources. This performance improvement project involved the development of a secure photo sharing web portal and photo triage clinical pathway to help burn practitioners appropriately triage burn patients being evaluated at health care facilities within the catchment area of an American Burn Association verified adult and pediatric burn center. Methods Existing technology was used to develop a burn photo sharing web portal that can be easily accessed by providers outside the burn center. A new clinical pathway for burn photo triage was developed. Education was formulated for nurses and providers within the burn center and for referring facilities. Retrospective data was collected for the 4 years of ambulance transfers captured in the outpatient burn registry prior to the implementation of the photo triage clinical pathway. Comparison data was also abstracted for the first year after implementation. Patients were categorized as over triaged or appropriately triage based on the first set of photos captured in the EMR. Results In the pre-triage years there were a total of 242 ambulance transfers to the outpatient burn clinic. 150 (62%) of those patients were appropriately triaged, while 92 (38%) were over triaged. In the year following implementation there were 27 ambulance transfers to the outpatient burn clinic. 25 (92.6%) of these patients were appropriately triaged while 2 (7.4%) were over triaged. Overall ambulance transfers to the outpatient burn clinic dropped by more than 50% (average of 60.5 transfer per year down to 27 after implementation). Conclusions Patients with burn injuries at referring facilities were more appropriately triaged when using photos of wounds which ultimately reduced the number of unnecessary ambulance transfers.
26
Dallaire, Clémence, Julien Poitras, Karine Aubin, André Lavoie, Lynne Moore, and Geneviève Audet. "Interrater agreement of Canadian Emergency Department Triage and Acuity Scale scores assigned by base hospital and emergency department nurses." CJEM 12, no. 01 (January 2010): 45–49. http://dx.doi.org/10.1017/s148180350001201x.
Full textAbstract:
ABSTRACTObjective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.
27
Tanner, Richard, Eugene Cassidy, and Iomhar O’Sullivan. "Does Using a Standardised Mental Health Triage Assessment Alter Nurses Assessment of Vignettes of People Presenting with Deliberate Self-Harm." Advances in Emergency Medicine 2014 (September 3, 2014): 1–9. http://dx.doi.org/10.1155/2014/492102.
Full textAbstract:
Background. The Manchester Triage Scale is used in Irish emergency departments. This fails to provide guidance on triaging psychiatric presentations. A Mental Health Triage scale is recommended by the National Institute of Clinical Excellence. Aim. To examine the effectiveness of a Mental Health Triage scale in assessing patients presenting with self-harm. Method. Ten vignettes were created, detailing cases of deliberate self-harm. Nurses (n=49) were given five vignettes and asked to assign each vignette to a triage category, using The Manchester Triage Scale. Each nurse was subsequently asked to reevaluate the same vignettes using the Mental Health Triage Scale. Triage with each method was deemed safe or unsafe, using the benchmark triage categories assigned by a consultant in psychiatry and a consultant in emergency medicine departments. Results. 245 cases were triaged. There was a significant change in the categories assigned when the Mental Health Triage scale was in use, P<0.001. The triage categories assigned using the Mental Health Triage scale were significantly safer than under the Manchester Triage Scale (79% versus 60% safe, respectively, P<0.001).
28
Ashkenazi, Itamar, Boris Kessel, Tawfik Khashan, Jacob Haspel, Meir Oren, Oded Olsha, and Ricardo Alfici. "Precision of In-Hospital Triage in Mass-Casualty Incidents after Terror Attacks." Prehospital and Disaster Medicine 21, no. 01 (February 2006): 20–23. http://dx.doi.org/10.1017/s1049023x00003277.
Full textAbstract:
AbstractIntroduction:Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan.Objective:The objective of this study was to assess the precision of triage in mass-casualty incidents.Methods:The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS).Results:Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 ≤ISS<16), and 11 severe (ISS < 16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%).Conclusion:Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.
29
Engan, Mette, Asle Hirth, and Håvard Trønnes. "Validation of a Modified Triage Scale in a Norwegian Pediatric Emergency Department." International Journal of Pediatrics 2018 (October 15, 2018): 1–8. http://dx.doi.org/10.1155/2018/4676758.
Full textAbstract:
Objective. Triage is a tool developed to identify patients who need immediate care and those who can safely wait. The aim of this study was to assess the validity and interrater reliability of a modified version of the pediatric South African triage scale (pSATS) in a single-center tertiary pediatric emergency department in Norway. Methods. This prospective, observational study included all patients with medical conditions, referred to the pediatric emergency department of a tertiary hospital in Norway from September 1, 2015, to November 17, 2015. Their assigned triage priority was compared with rate of hospitalization and resource utilization. Validity parameters were sensitivity, specificity, positive and negative predictive value, and percentage of over- and undertriage. Interrater agreement and accuracy of the triage ratings were calculated from triage performed by nurses on written case scenarios. Results. During the study period, 1171 patients arrived at the hospital for emergency assessment. A total of 790 patients (67 %) were triaged and included in the study. The percentage of hospital admission increased with increasing level of urgency, from 30 % of the patients triaged to priority green to 81 % of those triaged to priority red. The sensitivity was 74 %, the specificity was 48 %, the positive predictive value was 52 %, and the negative predictive value was 70 % for predicting hospitalization. The level of over- and undertriage was 52 % and 26 %, respectively. Resource utilization correlated with higher triage priority. The interrater agreement had an intraclass correlation coefficient of 0.99 by Cronbach’s alpha, and the accuracy was 92 %. Conclusions. The modified pSATS had a moderate sensitivity and specificity but showed good correlation with resource utilization. The nurses demonstrated excellent interrater agreement and accuracy when triaging written case scenarios.
30
Lin, Daren, and Andrew Worster. "Predictors of admission to hospital of patients triaged as nonurgent using the Canadian Triage and Acuity Scale." CJEM 15, no. 06 (November 2013): 353–58. http://dx.doi.org/10.2310/8000.2013.130842.
Full textAbstract:
ABSTRACTObjectives:To identify factors known prior to triage that might have predicted hospital admission for patients triaged by the Canadian Triage Acuity Scale (CTAS) as level 5 (CTAS 5, nonurgent) and to determine whether inappropriate triage occurred in the admitted CTAS 5 patients.Methods:We reviewed the triage records of patients triaged as CTAS 5 at the emergency departments (EDs) of three tertiary care hospitals between April 2002 and September 2009. Two triage nurses unaware of the study objective independently assigned the CTAS level in 20% of randomly selected CTAS 5 patients who were admitted. We used the kappa statistic (κ) to measure the agreement among the raters in CTAS level between the assessment of the research nurses and the original triage assessment and regression analysis to identify independent predictors of admission to hospital.Results:Of the 37,416 CTAS 5 patients included in this study, 587 (1.6%) were admitted. Agreement on CTAS assignment in CTAS 5 patients who were admitted was κ −0.9, (95% confidence interval [CI] 20.96 to 20.84). Age over 65 (odds ratio [OR] 5.46, 95% CI 4.57 to 6.53) and arrival by ambulance (OR 7.42, 95% CI 6.15 to 8.96) predicted hospital admission in CTAS 5 patients.Conclusions:Most of the CTAS 5 patients who were subsequently admitted to hospital may have qualified for a higher triage category. Two potential modifiers, age over 65 and arrival by ambulance, may have improved the prediction of admission in CTAS 5 patients. However, the consistent application of existing CTAS criteria may also be important to prevent incorrect triage.
31
Stackhouse, S., G. Innes, and E. Grafstein. "LO62: Variability in triage performance for chest pain patients in two Canadian cities." CJEM 20, S1 (May 2018): S28—S29. http://dx.doi.org/10.1017/cem.2018.124.
Full textAbstract:
Introduction: CTAS triage acuity determinations are used to prioritize patients, describe illness acuity, and compare casemix across institutions. The latter functions assume reliable application in diverse settings, but no studies have evaluated this using actual triage data. Methods: This administrative database study included all patients with a triage complaint of chest pain (CP) in Vancouver (2012-16) and Calgary (2016). We stratified patients into high vs. non-high severity groups based on discharge diagnoses. High severity diagnoses included all patients with aortic pathology, ACS, shock or arrest states, as well as patients requiring admission because of pulmonary embolism, dysrhythmias, CHF, neurologic or respiratory conditions. We dichotomized patient triage assignments to high (CTAS 1,2) vs. low (3,4,5) acuity, then constructed 2x2 tables correlating CTAS acuity with disease severity. Main outcomes included the proportion of CP patients triaged to high acuity categories and CTAS sensitivity for high severity conditions. Results: We studied 97277 Vancouver and 18622 Calgary patients. Age (mean, 54.8 years), sex (53.5% male) and casemix distributions were similar between cities, although Calgary had more high severity conditions (15.0% v. 10.5%) and a higher admission rate (22.5% v. 21.4%). Calgary triage nurses placed more patients in high acuity triage categories (85.1% vs. 45.2%) and achieved higher sensitivity for severe illness (96.2% vs. 76.2%); however, they were less accurate (28.7% vs. 60.3%) and less specific (16.8% vs. 58.4%). The proportion of CP patients triaged into high acuity categories ranged from 79% to 87% across four Calgary hospitals and from 28% to 62% at five Vancouver hospitals. Conclusion: This study shows profoundly different triage categorization at different sites seeing similar patient populations. Triage nurses are taught to strive for high sensitivity, but there may be operational consequences if specificity drops too low and large numbers of non-severe patients are triaged into high acuity categories. It is not clear which approach is better but these data suggest CTAS should not be used to compare patient acuity or complexity across different hospitals or regions.
32
McGlynn, Nicholas, Ilene Claudius, Amy H. Kaji, Emilia H. Fisher, Alaa Shaban, Mark X. Cicero, Genevieve Santillanes, Marianne Gausche-Hill, Todd P. Chang, and J. Joelle Donofrio-Odmann. "Tabletop Application of SALT Triage to 10, 100, and 1000 Pediatric Victims." Prehospital and Disaster Medicine 35, no. 2 (February 14, 2020): 165–69. http://dx.doi.org/10.1017/s1049023x20000163.
Full textAbstract:
AbstractIntroduction:The Sort, Access, Life-saving interventions, Treatment and/or Triage (SALT) mass-casualty incident (MCI) algorithm is unique in that it includes two subjective questions during the triage process: “Is the victim likely to survive given the resources?” and “Is the injury minor?”Hypothesis/Problem:Given this subjectivity, it was hypothesized that as casualties increase, the inter-rater reliability (IRR) of the tool would decline, due to an increase in the number of patients triaged as Minor and Expectant.Methods:A pre-collected dataset of pediatric trauma patients age <14 years from a single Level 1 trauma center was used to generate “patients.” Three trained raters triaged each patient using SALT as if they were in each of the following scenarios: 10, 100, and 1,000 victim MCIs. Cohen’s kappa test was used to evaluate IRR between the raters in each of the scenarios.Results:A total of 247 patients were available for triage. The kappas were consistently “poor” to “fair:” 0.37 to 0.59 in the 10-victim scenario; 0.13 to 0.36 in the 100-victim scenario; and 0.05 to 0.36 in the 1,000-victim scenario. There was an increasing percentage of subjects triaged Minor as the number of estimated victims increased: 27.8% increase from 10- to 100-victim scenario and 7.0% increase from 100- to 1,000-victim scenario. Expectant triage categorization of patients remained stable as victim numbers increased.Conclusion:Overall, SALT demonstrated poor IRR in this study of increasing casualty counts while triaging pediatric patients. Increased casualty counts in the scenarios did lead to increased Minor but not Expectant categorizations.
33
Smart, David, Cecily Pollard, and Bryan Walpole. "Mental Health Triage in Emergency Medicine." Australian & New Zealand Journal of Psychiatry 33, no. 1 (February 1999): 57–66. http://dx.doi.org/10.1046/j.1440-1614.1999.00515.x.
Full textAbstract:
Objective: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. Method: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. Results: Afour-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health ‘did not waits’ showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. Conclusions: Asystematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.
34
Ouellet, Simon, Guy Bélanger, and Mélanie Bérubé. "Interrater Reliability of a Tool Measuring the Quality of Nursing Triage in the Emergency Department." Science of Nursing and Health Practices 4, no. 2 (February 16, 2022): 86–100. http://dx.doi.org/10.7202/1086403ar.
Full textAbstract:
Introduction: Triage plays an essential role in the Emergency Department (ED), helping maintain a safe patient flow. Although assessing the quality of the triage process is crucial, to date, there has been no metrological testing of a tool measuring the quality of nursing triage. Objective: This study aimed to assess the interrater reliability of the Audit Triage Tool (ATT) in Quebec, Canada. Methods: This retrospective cohort study took place in a regional ED. Fifty triages were selected using a systematic random sampling technique with quotas of 10 triages grouped under 5 chief complaints: chest pain, abdominal pain, neurological problems, major blunt trauma and fever. A total of 4 auditors individually applied the 49 criteria of the ATT to 50 triages. The interrater reliability was measured with the intraclass correlation coefficient (ICC), percentage of unanimity (PU) and percentage of agreement (PA). Results: Based on the ICC, 33/49 criteria showed fair (ICC 0.60, comparatively to only 2/26 implicit criteria. Discussion and conclusion: Findings showed that a quarter of the ATT criteria had poor interrater reliability according to various statistical tests. Solutions to improve the reliability of the ATT, mostly regarding the implicit criteria, are needed. Finally, future methodological research on triage quality assessment should focus on a thorough validation of the ATT.
35
Postma, I. L. E., H. Weel, M. Heetveld, F. Bloemers, T. Bijlsma, and J. C. Goslings. "(P2-93) Triage During a Mass Casualty Incident: The 2009 Turkish Airlines Crash in Amsterdam." Prehospital and Disaster Medicine 26, S1 (May 2011): s166—s167. http://dx.doi.org/10.1017/s1049023x11005383.
Full textAbstract:
IntroductionTriage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?MethodsA retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.ResultsThere was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.ConclusionsAfter the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.
36
McLeod, S. L., J. McCarron, K. Stein, S. Scott, H. J. Ovens, N. Mittman, and B. Borgundvaag. "LO75: Interrater agreement and time it takes to assign a Canadian Triage and Acuity Scale score in 7 emergency departments." CJEM 19, S1 (May 2017): S54. http://dx.doi.org/10.1017/cem.2017.137.
Full textAbstract:
Introduction: The Canadian Triage and Acuity Scale (CTAS) is the standard used in all Canadian (and many international) emergency departments (EDs) for establishing the priority by which patients should be assessed. In addition to its clinical utility, CTAS has become an important administrative metric used by governments to estimate patient care requirements, ED funding and workload models. Despite its importance, the process by which CTAS scores are derived is highly variable. Emphasis on ED wait times has also drawn attention to the length of time the triage process takes. The primary objective of this study was to determine the interrater agreement of CTAS in current clinical practice. The secondary objective was to determine the time it takes to triage in a variety of ED settings. Methods: This was a prospective, observational study conducted in 7 hospital EDs, selected to represent a mix of triage processes (electronic vs. manual), documentation practices (electronic vs. paper), hospital types (rural, community and teaching) and patient volumes (annual ED census ranged from 38,000 to 136,000). An expert CTAS auditor observed on-duty triage nurses in the ED and assigned independent CTAS in real time. Research assistants not involved in the triage process independently recorded the triage time. Interrater agreement was estimated using unweighted and quadratic-weighted kappa statistics with 95% confidence intervals (CIs). Results: 738 consecutive patient CTAS assessments were audited over 21 seven-hour triage shifts. Exact modal agreement was achieved for 554 (75.0%) patients. Using the auditor’s CTAS score as the reference standard, on-duty triage nurses over-triaged 89 (12.1%) and under-triaged 95 (12.9%) patients. Interrater agreement was “good” with an unweighted kappa of 0.63 (95% CI: 0.58, 0.67) and quadratic-weighted kappa of 0.79 (95% CI: 0.67, 0.90). Research assistants captured triage time for 3808 patients over 69 shifts at 7 different EDs. Median (IQR) triage time was 5.2 (3.8, 7.3) minutes and ranged from 3.9 (3.1, 4.8) minutes to 7.5 (5.8, 10.8) minutes. Conclusion: Variability in the accuracy, and length of time taken to perform CTAS assessments suggest that a standardized approach to performing CTAS assessments would improve both clinical decision making, and administrative data accuracy.
37
Raviolo, M., M. Bortolin, M. Vivalda, and D. Bono. "(P2-96) A Single, Simple Triage Method." Prehospital and Disaster Medicine 26, S1 (May 2011): s167. http://dx.doi.org/10.1017/s1049023x11005413.
Full textAbstract:
IntroductionAt this time, no triage method is considered better than another in comparison to the outcome of the casualties. It is important and useful to identify a triage method that can be used for both adults and children at the same time. It should consider the anatomical and physiological differences between adults, children, and infants.ObjectivesTo revise and adapt the current triage system in use in the Piemonte Emergency Medical Services for the first triage in a validated method that is effective for adults, children, and babies in order to unify and simplify the triage system.MethodsIn accordance with pediatricians, the “Triage Sieve” procedure and parameters were revised into a single method.ResultsSetting the height of the casualty was considered to be both quick and easy. In this revised method, all the casualties are classified with the sieve methods, but some changes have been introduced. Casualties with a stature < 59 cm are classified as infants, and are therefore priority T1 (red) in every case. Casualties > 60 cm but < 120 cm in stature are classified as children. Children with a respiratory rate < 15 or > 40 breaths per minute and a heart rate < 80 or > 160 beats per minute are classified as T1.ConclusionsChildren will probably be over-triaged in this method, but the authors do not consider that a substantial problem. This first triage system is simple and effective. But, it has not yet been tested effectively during an actual mass-casualty incident or disaster.
38
Gravel, Jocelyn, Sergio Manzano, and Michael Arsenault. "Safety of a modification of the triage level for febrile children 6 to 36 months old using the Paediatric Canadian Triage and Acuity Scale." CJEM 10, no. 01 (January 2008): 32–37. http://dx.doi.org/10.1017/s1481803500009982.
Full textAbstract:
ABSTRACT Objective: The Paediatric Canadian Triage and Acuity Scale (PaedCTAS) stipulates that febrile patients who are 3 to 36 months old should be triaged to the PaedCTAS 3 “urgent” category. To optimize resource use, we implemented a protocol enabling these children to be down-triaged to the PaedCTAS 4 “less urgent” category if there was no sign of toxicity. Our objective was to evaluate the safety of this triage protocol modification. Methods: This retrospective cohort study evaluated all patients triaged in an urban tertiary pediatric hospital during a 6-month period between November 22, 2005, and May 22, 2006. Data were retrieved from the emergency department (ED) database and rates of hospitalization and intensive care unit (ICU) admission were compared for 4 groups: all patients triaged as urgent (level 3), all febrile patients from 3 to 36 months old triaged as urgent (level 3), all patients triaged as less urgent (level 4) and all febrile patients aged 3 to 36 months old who were down-triaged to less urgent (level 4). Results: There were 36 285 total ED visits during the study period, including 3477 febrile children who were 3 to 36 months old. Nurses down-triaged 1869 febrile children (54%) to the level-4 (less urgent) category and left 1322 (38%) in the level-3 (urgent) category. Hospitalization rate for down-triaged febrile patients was similar to that seen for all PaedCTAS 4 patients (2.4% v. 2.8%, 95% confidence interval for difference –0.3% to 1.1%). Down-triaged patients had significantly lower admission rates than those remaining in the level-3 (urgent) category (absolute risk reduction 10.7% standard deviation 1.9%, p < 0.001). No down-triaged patient died or required ICU admission. Conclusion: Febrile children aged 6 to 36 months who have no signs of toxicity can safely be down-triaged, based on triage nurse clinical judgement, to the less urgent PaedCTAS 4 category. This modification would affect the triage level of approximately 5% of all pediatric ED visits.
39
Zhang, David, Bradley Shy, and Nicholas Genes. "Early Rooming Triage: Accuracy and Demographic Factors Associated with Clinical Acuity." Western Journal of Emergency Medicine 23, no. 2 (February 28, 2022): 145–51. http://dx.doi.org/10.5811/westjem.2021.12.53873.
Full textAbstract:
Introduction: Early rooming triage increases patient throughput and satisfaction by rapidly assigning patients to a definitive care area, without using vital signs or detailed chart review. Despite these operational benefits, the clinical accuracy of early rooming triage is not well known. We sought to measure the accuracy of early rooming triage and uncover additional patient characteristics that can assist triage. Methods: We conducted a single-center, retrospective population study of walk-in emergency department (ED) patients presenting to the ED via an early rooming triage system, examining triage accuracy and demographic factor correlation with higher acuity ED outcomes. Results: Among all patients included from the three-year study period (N = 238,457), early rooming triage was highly sensitive (0.89) and less specific (0.61) for predicting which patients would have a severe outcome in the ED. Patients triaged to the lowest acuity area of the ED experienced severe outcomes in 4.39% of cases, while patients triaged to the highest acuity area of the ED experienced severe outcomes in 65.9% of cases. An age of greater than 43 years (odds ratio [OR] 3.48, 95% confidence interval: 3.40, 3.57) or patient’s home address farther from the ED ([OR] 2.23 to 3.08) were highly correlated with severe outcomes. Multivariable models incorporating triage team judgment were robust for predicting severe outcomes at triage, with an area under the receiver operating characteristic of 0.82. Conclusion: Early rooming workflows are appropriately sensitive for ED triage. Consideration of demographic factors, automated or otherwise, can augment ED processes to provide optimal triage.
40
Seefeld, Andrew W. "Triage." Journal of Emergency Nursing 34, no. 1 (February 2008): 9–10. http://dx.doi.org/10.1016/j.jen.2007.10.005.
Full text
41
Kovacs, M., and S. Campbell. "LO31: Triage drift: Variation in application of the Canadian Triage Acuity Scale between triage nurses compared to triage paramedics in response to overcrowding pressures in an emergency department." CJEM 22, S1 (May 2020): S18. http://dx.doi.org/10.1017/cem.2020.87.
Full textAbstract:
Introduction: CTAS is a validated five-level triage score utilized in EDs across Canada and internationally. Moderate interrater reliability between prehospital paramedic and triage nurse application of CTAS during clinical practice has been found. This study is the first assessment of the variation in distribution of CTAS scores with increasing departmental pressure as measured by the NEDOCs scale comparing triage allocations made by triage nurses with those made by triage paramedics. Methods: We conducted a retrospective, observational cohort study of EDIS data of all patients triaged in the Halifax Infirmary Emergency Department from January 1, 2017-May 30, 2017 and January 1, 2018 - May 30, 2018. CTAS score assignment by nursing and paramedic triage staff were compared with increasing levels of ED overcrowding, as determined by the department NEDOCS score. Results: Nurses were more likely to assign higher acuity scores in all situations of department crowding; there was a 3% increased probability that a nurse, as compared to a paramedic, would triage as emergent when the ED was not overcrowded (Pearson chi-square(1) = 4.21, p < 0.05, Cramer's v = 0.028, n = 5314), and a 10% increased probability that a nurse, as compared to a paramedic, would triage a patient as emergent when EDs were overcrowded (Pearson chi-square(1) = 623.83, p < 0.001, Cramer's v = 0.11, n = 56 018). Conclusion: Increasing levels of ED overcrowding influence triage nurse CTAS score assignment towards higher acuity to a greater degree than scores assigned by triage paramedics.
42
Salhanick, Steven D., William Sheahan, and Jeffrey J. Bazarian. "Use and Analysis of Field Triage Criteria for Mass Gatherings." Prehospital and Disaster Medicine 18, no. 4 (December 2003): 347–52. http://dx.doi.org/10.1017/s1049023x00001308.
Full textAbstract:
AbstractIntroduction:Mass gatherings may result in an acute increase in the number of people seeking medical care potentially causing undue stress to local emergencymedical services (EMS) and hospitals. Often, temporary medical facilities are established within the mass gathering venue. Emergency Medical Services providers encountering patients in the field should be equipped with effective protocols to determine transport destination (venue facility vs. hospital).Hypothesis:Paramedics are capable of appropriately using triage criteria written specifically for a particular mass gathering. The use of triage criteria, when appliedcorrectly, decreases over-triage to the venue facility and under-triage to the hospital.Methods:Paramedics triaged patients at a mass gathering to a temporary venue facility or to a single emergency department using criteria specific for the event. Cases were reviewed to determine if the patients transported went to an appropriate facility and if the triage criteria were applied appropriately. Results: Transport destination was consistent with that dictated by the criteria for 78% of cases. Analysis of these cases shows that the criteria had a sensitivity of 100% (95% CI = 58–100%) and a specificity of 90% (95% CI = 73–98%) for predicting which patients needed hospital services and which could be cared for safely in the temporary clinic setting.Conclusions:Triage by paramedics at the point of patient contact may reduce transporting of patients to hospitals unnecessarily. Patients in need of hospital services were identified. Point-of-contact triage should be applied in mass gatherings.
43
Sandell, Julian M., and I. K. Maconochie. "The Impact of Terrorism on Children: A Two-Year Experience." Prehospital and Disaster Medicine 19, no. 04 (December 2004): 370–71. http://dx.doi.org/10.1017/s1049023x00002016.
Full textAbstract:
Waismanet al1have once more highlighted the very real challenge of triaging children in mass-casualty events (MCE) in the pre-hospital setting. Difficulties encountered measuring vital signs and different patterns of injury, reflecting significant anatomical and physiological differences, necessitates a modified approach when applying traditional “adult” triage methods to paediatric trauma victims. When using physiological parameters to triage children, their faster respiratory rates and heart rates frequently result in younger children being triaged to a higher category than their injuries demand. These differences become less apparent during adolescence, as the young person matures into adulthood.
44
Cumming, M. "Book Review: Emergency Triage." Scottish Medical Journal 42, no. 6 (December 1997): 191. http://dx.doi.org/10.1177/003693309704200611.
Full text
45
FitzGerald, G., G. A. Jelinek, D. Scott, and M. F. Gerdtz. "Emergency department triage revisited." Emergency Medicine Journal 27, no. 2 (February 1, 2010): 86–92. http://dx.doi.org/10.1136/emj.2009.077081.
Full text
46
Smith, Sara. "Triage in emergency psychiatry." Psychiatric Bulletin 24, no. 11 (November 2000): 433. http://dx.doi.org/10.1192/pb.24.11.433.
Full text
47
Morrison, Audrey, Alastair Hull, and Beryl Shepherd. "Triage in emergency psychiatry." Psychiatric Bulletin 24, no. 7 (July 2000): 261–64. http://dx.doi.org/10.1192/pb.24.7.261.
Full textAbstract:
Aims & MethodPsychiatric emergencies constitute a large proportion of psychiatric referrals, with the response to this need therefore of great importance. The impact of the introduction of a telephone triage system on such factors as speed of response, assessment site, outcome and the personnel performing the assessment is examined within the context of closing of a 24-hour open access emergency system. Information was gathered from all emergency referrals, with 80 subjects randomly chosen and studied in depth.ResultsThe triage system afforded a greater flexibility of response, and the involvement of more experienced clinicians. It did not reduce the overall referral or admission rates.Clinical ImplicationsTriage was found to be an effective method of introducing flexibility of response to emergency referrals while encouraging continuity of patient care.
48
Gerdtz, Marie Frances, Marnie Collins, Matthew Chu, Audas Grant, Robin Tchernomoroff, Cecily Pollard, Judy Harris, and Jeff Wassertheil. "Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education Kit." Emergency Medicine Australasia 20, no. 3 (June 2008): 250–59. http://dx.doi.org/10.1111/j.1742-6723.2008.01089.x.
Full text
49
Malyon, Lorelle, Alison Williams, and Robert S. Ware. "The Emergency Triage Education Kit: Improving paediatric triage." Australasian Emergency Nursing Journal 17, no. 2 (May 2014): 51–58. http://dx.doi.org/10.1016/j.aenj.2014.02.002.
Full text
50
Dong, S. L. "Emergency Triage: Comparing a Novel Computer Triage Program with Standard Triage." Academic Emergency Medicine 12, no. 6 (June 1, 2005): 502–7. http://dx.doi.org/10.1197/j.aem.2005.01.005.
Full text