Do prehospital providers and emergency nurses agree on triage assignment?: an efficacy study

Skjøt‐Arkil, Helene; Pontoppidan, Louise L; Laursen, Jens Ole; Giebner, Matthias; Andersen, Jesper D; Mogensen, Christian Backer

doi:10.1097/mej.0000000000000503

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Studies of RETTS-A (ED) have reported that increased mortality and inhospital stay were associated with a higher triage level, with an ED nurse inter-reliability of moderate to good [11,12]. Studies of the Danish emergency process triage (DEPT), the Canadian triage and acuity scale (CTAS), and the emergency severity index (ESI) have reported only moderate agreement between EMS clinicians and ED nurses when utilising identical triage systems [13][14][15]. RETTS-A was not developed to be utilised as a system assessing whether low-acuity patients should stay at the scene with self-care or referral to PC.…”

Section: Introductionmentioning

confidence: 99%

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

2020

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Background: Crowding in the emergency department (ED) is a safety concern, and pathways to bypass the ED have been introduced to reduce the time to definitive care. Conversely, a number of low-acuity patients in the ED could be assessed by the emergency medical services (EMS) as requiring a lower level of care. The limited access to primary care in Sweden leaves the EMS nurse to either assess the patient as requiring the ED or to stay at the scene. This study aimed to assess patient characteristics and evaluate the initial assessment by and utilisation of the ambulance triage system and the appropriateness of non-transport decisions. Methods: A prospective observational study including 6712 patients aged ≥16 years was conducted. The patient records with 72 h of follow-up for non-transported patients were reviewed. Outcomes of death, time-critical conditions, complications within 48 h and final hospital assessment were evaluated. The Mann-Whitney U test, Fisher's exact test, and Spearman's rank correlation were used for statistical analysis. Results: The median patient age was 66 years, and the most common medical history was a circulatory diagnosis. Males received a higher priority from dispatchers and were more frequently assessed at the scene as requiring hospital care. A total of 1312 patients (19.7%) were non-transported; a history of psychiatric disorders or no medical history was more commonly noted among these patients. Twelve (0.9%) of the 1312 patients not transported were later admitted with time-critical conditions. Full triage was applied in 77.4% of the cases, and older patients were triaged at the scene as an 'unspecific condition' more frequently than younger patients. Overall, the 30-day mortality was 4.1% (n = 274). Conclusions: Age, sex, medical history, and presentation all appear to influence the initial assessment. A number of patients transported to ED could be managed at a lower level of care. A small proportion of the non-transported patients were later diagnosed with a time-critical condition, warranting improved assessment tools at the scene and education of the personnel focusing on the elderly population. These results may be useful in addressing resource allocation issues aiming at increasing patient safety.

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Section: Introductionmentioning

confidence: 99%

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

2020

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“…5 Several methods are used worldwide to assess and prioritise (triage) patients in the chain of emergency care. [6][7][8] Examples are the Manchester Triage Scale, the Australasian Triage Scale, the Canadian Triage and Acuity Scale and the South African Triage Scale (SATS). [9][10][11][12][13] Effective triage should rapidly identify patients with life-threatening conditions in need of immediate care and ensure that each patient receives similar initial assessment, facilitating further diagnostic work-up and treatment.…”

Section: Introductionmentioning

confidence: 99%

Implementing a new emergency medical triage tool in one health region in Norway: some lessons learned

et al. 2022

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BackgroundAcutely sick or injured patients depend on ambulance and emergency department personnel performing an accurate initial assessment and prioritisation (triage) to effectively identify patients in need of immediate treatment. Triage also ensures that each patient receives fair initial assessment. To improve the patient safety, quality of care, and communication about a patient’s medical condition, we implemented a new triage tool (the South African Triage Scale Norway (SATS-N) in all the ambulance services and emergency departments in one health region in Norway. This article describes the lessons we learnt during this implementation process.MethodsThe main framework in this quality improvement (QI) work was the plan–do–study–act cycle. Additional process sources were ‘The Institute for Healthcare Improvement Model for improvement’ and the Norwegian Patient Safety Programme.ResultsBased on the QI process as a whole, we defined subjects influencing this work to be successful, such as identifying areas for improvement, establishing multidisciplinary teams, coaching, implementing measurements and securing sustainability. After these subjects were connected to the relevant challenges and desired effects, we described the lessons we learnt during this comprehensive QI process.ConclusionWe learnt the importance of following a structured framework for QI process during the implementation of the SATS-N triage tool. Furthermore, securing anchoring at all levels, from the managements to the medical professionals in direct patient-orientated work, was relevant important. Moreover, establishing multidisciplinary teams with ambulance personnel, emergency department nurses and doctors with various medical specialties provided ownership to the participants. Meanwhile, coaching provided necessary security for the staff directly involved in caring for patients. Keeping the spirit and perseverance high were important factors in completing the implementation. Establishment of the regional network group was found to be important for sustainability and further improvements.

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“…Currently all countries face increase in the number of patients visiting emergency departments, which provide them with primary access to a health care system [1]. This situation is explained by the lack of clinical guidelines developed for management of emergency pathologies at the preclinical stage [2]. The number of patients admitted to emergency departments cannot be predicted with great precision; and only a fraction of those suffers from lifethreatening diseases or conditions requiring urgent care [3], and not all patients are in need of immediate medical care.…”

Section: Introductionmentioning

confidence: 99%

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2021

Russ Open Med J

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Medical sorting is aimed at assessment of disease severity and has to be carried out within a short time to determine the priorities for patient care and transportation to the most appropriate place for future treatment. The goal of this study was to provide an integrative review by analyzing the publications on the most common triage systems worldwide in order to select and implement the most reliable system at emergency departments. We searched for publications relevant to our comparative analysis in evidence-based medicine databases. A total of 1,740 literary sources were identified, of which 42 were selected for analysis. Comparative analysis of different triage systems may help implementing the most efficient system in Kazakhstan. The Emergency Severity Index is considered the most reliable and accurate tool used in international practice, and it could provide a basis for introduction of triage system at emergency departments in Kazakhstan.

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Do prehospital providers and emergency nurses agree on triage assignment?: an efficacy study

Abstract: There was a moderate interrater agreement on triage assignment between ED nurses and prehospital providers. They agreed on final triage more often if they agreed on triage based on vital signs rather than presenting complaints.

Cited by 5 publications

References 16 publications

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

Patient characteristics, triage utilisation, level of care, and outcomes in an unselected adult patient population seen by the emergency medical services: a prospective observational study

Implementing a new emergency medical triage tool in one health region in Norway: some lessons learned

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