Emergency department triage revisited (original) (raw)
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Republished paper: Emergency department triage revisited
Postgraduate Medical Journal, 2010
Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.
Modern triage in the emergency department
2010
Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times ("crowding"), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability. Review of selected literature retrieved by a search on the terms "emergency department" and "triage." Emergency departments around the world use different triage systems to assess the severity of incoming patients' conditions and assign treatment priorities. Our study identified four such instruments: the Australasian Triage Scale (ATS), the Canadian Triage and Acuity Scale (CTAS), the Manchester Triage System (MTS), and the Emergency Severity Index (ESI). Triage instruments with 5 levels are superior to those with 3 levels in both validity and reliability (p<0.01). Good to very good reliability has been shown for the best-studied instruments, CTAS and ESI (κ-statistics: 0.7 to 0.95), while ATS and MTS have been found to be only moderately reliable (κ-statistics: 0.3 to 0.6). MTS and ESI are both available in German; of these two, only the ESI has been validated in German-speaking countries. Five-level triage systems are valid and reliable methods for assessment of the severity of incoming patients' conditions by nursing staff in the emergency department. They should be used in German emergency departments to assign treatment priorities in a structured and dependable fashion.
Accuracy of Triage in Service in The Emergency Department (Literature Review)
Journal of Scientific Research, Education, and Technology (JSRET)
Service accuracy is the minimum standard of service that must be achieved by nurses in the emergency room, so that proper triage implementation is needed. Triage is the classification of patients based on the level of emergency by prioritising actions on airway (A), breathing (B), and circulation (C) disorders by considering facilities, human resources and the probability of patient life. The literature search in this literature review uses six databases with high and medium quality criteria, namely scient driect, IEEG, cedekia, Sci-hub, ProQuest, Pubmed. For previous studies using correlational analytics with a cross-sectional study approach, descriptive: combination (mixed methods) with sequential explanatory design. cross sectional. Check Prisma to guide this review. Titles, abstracts, full text and methodology were assessed for study eligibility. Data were tabulated and analysed narratively. Results: Nine journal literature met the inclusion criteria, with the major theme of tri...
Emergency Care Journal, 2013
In Italy there are many triage guidelines and methods based on consensus. But, to our knowledge, there are few data on the reliability and predictive validity of triage systems adopted by Italian emergency departments. The Triage Emergency Method version 2 (TEM v2) is a new four-level in-hospital triage system. This paper presentes a before-and-after observational study performed using triage scenarios from June 2008 to September 2009 in 6 Italian emergency departments. Twelve nurses who received a 5-h training on TEM and a panel of experts on TEM assigned priority code to 66 scenarios. To test the inter-rater reliability among participants and the panel of experts (before and after the course), we used the weighted K statistic. We assessed the validity of TEM by calculating sensitivity, specificity and accuracy for predicting the reference standard's triage score. The TEM v2 showed good and very-good agreement among all 6 groups of nurses with a K range=0.61-1. Also, sensitivity, specificity and accuracy of nurses' triage rating for predicting the reference standard's triage code was good (accuracy range=78-90%). In this multicenter study, TEM v2 has a good inter-rater reliability for rating triage acuity among all groups of participating nurses, with a K value similar to the reference standard reliability (K=0.75). Thus, the Triage Emergency Method version 2 seems to be valid and accurate in predicting a reference standard rating.
Mind the gap: triage guidelines and their utilisation at the emergency department
Nederlands Tijdschrift voor Evidence Based Practice, 2014
List of publications Dankwoord / Acknowledgements Curriculum Vitae Triage More and more patients visit hospital emergency departments (EDs), with urgent and non-urgent problems. 1 In the Netherlands, several explanations have been brought up with regard to overcrowding EDs, such as people bypassing the general practitioner (GP) and going straight to the ED and the proportional rise in the ageing population. 1,9 Overcrowded waiting rooms result in people needing care urgently without being treated in time. 10 Prioritising patients according to urgency of need for medical assessment is one possibility to overcome this problem. This is referred to as triage. 9,11-13 The term triage comes from the French verb 'trier' meaning to separate, sort, shift or select, and was applied to the sorting of military casualties. 14-15 Triage is a process of decision-making to prioritise treatment and needs of patients in ED based on clinical urgency. Triage is defined as the classification of patient acuity that characterises the degree to which the patient's condition is life-threatening and whether immediate treatment is needed to alleviate symptoms. 16 Triage nurses classify patients on the basis of their need for medical attention: patients with the highest medical needs will be treated first. Based on the classification, doctors need to see patients within the given urgency codes (Table 1). 9,17-19 Triage systems Worldwide, different triage systems are used. Systems most commonly used are the Australasian Triage Scale (ATS,
2016
Emergency department (ED) triage is used to identify patients ’ level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 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?
Validity of the Manchester Triage System in emergency care: A prospective observational study
PLOS ONE, 2017
Objectives To determine the validity of the Manchester Triage System (MTS) in emergency care for the general population of patients attending the emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different emergency care settings. Methods This was a prospective observational study in three European emergency departments. All consecutive patients attending the emergency department during a 1-year study period (2010-2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency. Results 288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) to 0.94 (95%CI 0.94-0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) to 0.83 (95%CI 0.79-0.87), and specificity from 0.83 (95%CI 0.82-0.83) to 0.89 (95%CI 0.88-0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) to 35.3 (95%CI 28.4-43.9) in adults and from 9.8 (95%CI 6.7-14.5) to 23.8 (95%CI 17.7-32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different emergency departments.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed:
M E D I C I N E Modern Triage in the Emergency Department
SUMMARY Background: Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times (" crowding "), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability.