Consistency of retrospective triage decisions as a standardised instrument for audit.

Goodacre, Steve; Gillett, Mark; Harris, R. D.; Houlihan, Kathleen

doi:10.1136/emj.16.5.322

Cited by 35 publications

(31 citation statements)

References 7 publications

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“…As Goodacre, Gillet, Harris, et al (1999) identified, when they performed a retrospective audit of nursing triage decisions using the NTS, there was only fair to moderate consistency between physician reviewers auditing triage decisions. Equally, as Brillman, Doezema, Tanberg, et al (1996) states, verifiable gold standards for triage do not exist.…”

Section: Simultaneous Parallel Codingmentioning

confidence: 99%

“…Patients with more than one presenting complaint may be triaged by more than one algorithm, each leading to a different category (Goodacre, Gillet, Harris, et al 1999). The TATTT is universally applied to all adult injury based presentations regardless of the aetiology of the patients presenting complaint.…”

Section: Algorithms and Triagementioning

confidence: 99%

“…If triage nurses fail to categorise patients appropriately then medical attention may be unacceptably delayed or unnecessarily expedited (Goodacre, Gillet, Harris, et al 1999). As a consequence there will be inequity in patient access to ED services, potential risks to patient safety, inefficiencies in the management of patient workload and difficulty in making meaningful comparisons between institutions based on triage categorisation data (Considine, Ung, Thomas, 2000;Goodacre, Gillet, Harris, et al 1999;Doherty, 1996;Monash Institute of Health Services Research, 2001). …”

Section: Introductionmentioning

confidence: 99%

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Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study

Wollaston

Fahey

McKay

et al. 2004

Accident and Emergency Nursing

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IntroductionIn Australia a nationally adopted five tiered triage scale called the Australasian Triage Scale (ATS) is used for the purpose of differentiating patient acuity levels for all patients that present to an Emergency Department (ED). The scale was formulated with the aim of promoting a standardized approach to triage. Numerous studies now suggest that the ATS has not been successful in achieving this intention. The Toowoomba Adult Trauma Triage Tool (TATTT) seeks to address this deficiency by providing a reproducible, reliable and valid method of triage categorisation, albeit in a select group of patients.

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Section: Simultaneous Parallel Codingmentioning

confidence: 99%

Section: Algorithms and Triagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study

Wollaston

Fahey

McKay

et al. 2004

Accident and Emergency Nursing

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“…Therefore these decisions can have a profound effect on the health outcomes of the patient (Considine et al, 2000). Failure to categorise patients appropriately may result in these patients receiving medical attention that is unacceptably delayed or unnecessarily expedited Bucknall, 2001 andGoodacre, 1999). This situation has implications for both the patient being triaged and the ability of the ED to function effectively.…”

Section: Introductionmentioning

confidence: 99%

Triage nurse perceptions of the use, reliability and acceptability of the Toowoomba Adult Triage Trauma Tool (TATTT)

Eley

Hegney

Wollaston

et al. 2005

Accident and Emergency Nursing

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SummaryObjective: The 'Toowoomba Adult Triage Trauma Tool' (TATTT) is a computerised clinical decision support tool developed to provide an evidence-based, valid and consistent method of triage assessment and categorisation. The objective of this study was to determine the most appropriate training and testing strategy for implementing the TATTT and to evaluate its acceptability for assisting in the triage prioritisation process. Methods: Triage nurses (15) from two hospitals underwent training in the TATTT and were tested on its application. Semi-structured interviews gathered their perceptions of the training, the methods for testing and the acceptability of the TATTT for assisting in triage. Results: The TATTT was viewed positively by all but one of the nurses. Participants believed that it provided clear direction in the triage assessment process, increased their confidence in reaching a decision and would be comfortable in adopting the TATTT in clinical practice. Conclusions:The study has shown that the TATTT is acceptable to users and is viewed as a viable alternative to current triage practice.

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“…In most cases, the triage nurse must rely upon general guidelines to assess urgency and prioritize care, and many triage decisions are based primarily on the nurse's own clinical experience. While the validity of the general triage process has recently been studied, [15][16][17][18][19][20][21][22][23][24] little is known about the ED triage of HIV-infected patients.…”

mentioning

confidence: 99%

Emergency Department Triage of Patients Infected with HIV

Haukoos

Witt

Zeumer

et al. 2002

Academic Emergency Medicine

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Objective: The emergency department (ED) and HIV specialty clinics are primary sources of care for persons infected with HIV. HIV disease may be complicated by vague and complex symptomatology, and determining the degree of illness at triage is often difficult. The goals of this project were to characterize the ED presentation of HIV-related conditions, to develop a clinical decision rule to triage HIV-infected patients, and to validate the rule in clinical practice. Methods: The study population consisted of ambulatory patients with self-reported HIV infection who presented for care to the ED of a 553-bed public hospital that serves a medically indigent, minority population. An Illness Severity Instrument was developed by an expert panel to serve as the criterion standard for defining medical urgency for HIV-infected patients presenting to the ED for care. Two phases of the study were conducted. Data from the first phase, a noninterventional cohort study, were used to develop a clinical decision rule for the ED triage of HIV-infected patients. The second phase was a prospective validation of the clinical decision rule. Results: During phase I, data from 542 patient visits were collected. Data from 441 (81%) patient visits were used in a classification and regression tree (CART) analysis to produce a decision rule, the Clinical Triage Instrument. During phase II, the prospective validation of the Clinical Triage Instrument, 156 patient visits occurred. Of these, 88 (56%) patient visits were triaged using the Clinical Triage Instrument and could be scored using the Illness Severity Instrument. The Clinical Triage Instrument accurately triaged 45 [51%; 95% confidence interval (95% CI) = 40% to 62%] patient visits, undertriaged 11 (13%; 95% CI = 6% to 21%) patient visits, and overtriaged 32 (36%; 95% CI = 26% to 47%) patient visits. Sensitivities and specificities for determining emergent, urgent, and nonurgent medical conditions by the Clinical Triage Instrument were 56% (95% CI = 31% to 75%) and 84% (95% CI = 74% to 92%), 71% (95% CI = 55% to 84%) and 39% (95% CI = 25% to 55%), and 18% (95% CI = 6% to 37%) and 93% (95% CI = 84% to 98%), respectively. The positive and negative predictive values for determining an emergent medical condition using the Clinical Triage Instrument were 48% (95% CI = 26% to 70%) and 88% (95% CI = 78% to 95%), respectively. The positive and negative predictive values for determining a nonurgent medical condition using the Clinical Triage Instrument were 56% (95% CI = 21% to 86%) and 71% (95% CI = 60% to 81%), respectively. Conclusions: The Clinical Triage Instrument was not sufficiently accurate for clinical use. Until accurate and reliable triage methods are developed, all patients infected with HIV who present to the ED for care should receive timely evaluation and care.

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Consistency of retrospective triage decisions as a standardised instrument for audit.

Cited by 35 publications

References 7 publications

Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study

Reliability and validity of the Toowoomba adult trauma triage tool: a Queensland, Australia study

Triage nurse perceptions of the use, reliability and acceptability of the Toowoomba Adult Triage Trauma Tool (TATTT)

Emergency Department Triage of Patients Infected with HIV

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