Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction

Ryan, Kimberley; Greenslade, Jaimi; Dalton, Emily; Chu, Kevin; Brown, Anthony; Cullen, Louise

doi:10.1016/j.aucc.2015.05.001

Cited by 13 publications

(10 citation statements)

References 14 publications

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“…This potentially incorrect triage acuity may cause delays in treatment and ultimately compromise patient outcomes. 12,31 Further, of those patients that were triaged with an ESI score of 1 or 2, 80% did not develop MACE. This may be an indication of being over-triaged, taking scarce and valuable resources away from patients that could potentially use them.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Unfortunately, prior studies have shown that nurses' accuracy rates of triaging suspected ACS patients are as low as 54%. 4,7,[9][10][11][12] The Emergency Severity Index (ESI) tool is the most commonly used triage tool in EDs across the United States. 13 It is a five-level ordinal scale used to categorize patients based on resource utilization in the ED and likelihood of admission.…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome

et al. 2020

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Background:The Emergency Severity Index (ESI) is a widely used tool to triage patients in Emergency Departments. The ESI tool is employed to assess all complaints and has significant limitation for accurately triaging patients with suspected acute coronary syndrome (ACS).Objective: We evaluated the accuracy of ESI in predicting serious outcomes in suspected ACS, and to assess the incremental re-classification performance if ESI is supplemented with a clinically validated tool used to risk stratify suspected ACS. Methods:We used existing-data from an observational cohort study of chest pain patients. We extracted ESI scores documented by triage nurses during routine medical care. Two independent reviewers adjudicated the primary outcome, incidence of 30-day major adverse cardiac events (MACE). We compared ESI to the well-established modified HEAR/T (patient History, Electrocardiogram, Age, Risk factors, but without Troponin) score.Results: Our sample included 750 patients (age 59 ± 17 years, 43% female, 40% black). A total of 145 patients (19%) experienced MACE. The area under the receiver operating characteristic curve for ESI score for predicting MACE was 0.656, compared to 0.796 for the modified HEAR/T score. Using the modified HEAR/T score, 181 out of the 391 (46%) false positives and 16 out of the 19 (84%) false negatives assigned by ESI could be reclassified correctly.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome

et al. 2020

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“…Generally, undertriage is a serious concern, and it is more critical than overtriage in dealing with cardiac patients in the ED. Undertriage rate may increase up to 20% for cardiac patients using Australasian Triage Scale (ATS) in the ED (7). Sanders and DeVon reported that the emergency nurse triage accuracy using the ESI triage scale was 54% for patients with chest pain (8).…”

Section: Used Resources Amentioning

confidence: 99%

“…Nurses' triage assessment of patients at the ED has been well documented in the literature. Cultural biases and stereotypes are reported for the triage of patients with suspicion of ACS (5)(6)(7). Unfortunately, nurses' accuracy in triaging patients with suspected ACS is as low as 54% (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Emergency Severity Index Plus Cardiac Troponin I Rapid Test and Emergency Severity Index in Patients Presenting with Low-risk Chest Pain: A Randomized Clinical Trial

2021

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Background: There is difficulty in identifying low-risk patients with acute coronary syndrome in the emergency department (ED). Objectives: The aim of this study was to compare mistriage between the Emergency Severity Index (ESI) plus the cardiac troponin I rapid test (cTnI) and ESI among patients with chest pain. Methods: A randomized clinical trial was conducted from January to April 2019. One hundred patients with low-risk chest pain were randomly allocated to the ESI + cTnI and ESI groups. Triage levels, used resources, and mistriage rate were compared between both groups among patients discharged from the ED and admitted to the cardiac unit (CU) or coronary care unit (CCU). Results: Our samples included 100 patients (age: 52.9 ± 13.92 years; 51% female) who were equally assigned to the ESI + cTnI and ESI groups. Overtriage rate was 6% and 88% for the ESI + cTnI and ESI groups, respectively. The triage level between the ESI + cTnI and ESI groups was significantly different among patients who were discharged from the ED (3.92 vs. 3.00). Conclusions: The ESI + cTnI score seems to be more valid than the ESI scale to triage patients with low-risk chest pain. It is recommended to add cTnI to the ESI for the triage of patients with low-risk chest pain in the ED.

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“…The Emergency Department (ED) can become a very chaotic place where every minute counts and a timely intervention can be critical to patient survival. Patients consult for a variety of reasons, and it is often the nurse's responsibility to perform triage to determine their treatment priority (Mosley et al, 2013;Ryan et al, 2016). The adequacy of patient management for those requiring priority care, depends mainly on the quality of the triage performed by the nurse upon their arrival at the ED (Ordre des infirmiers et infirmières du Québec [OIIQ] & Collège des médecin du Québec [CMQ], 2019).…”

Section: Introductionmentioning

confidence: 99%

Interrater Reliability of a Tool Measuring the Quality of Nursing Triage in the Emergency Department

Ouellet

Bélanger

Bérubé

2022

Science of Nursing and Health Practices

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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.

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Factors associated with triage assignment of emergency department patients ultimately diagnosed with acute myocardial infarction

Cited by 13 publications

References 14 publications

The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome

The Association Between Patient Outcomes and the Initial Emergency Severity Index Triage Score in Patients With Suspected Acute Coronary Syndrome

Comparison Between Emergency Severity Index Plus Cardiac Troponin I Rapid Test and Emergency Severity Index in Patients Presenting with Low-risk Chest Pain: A Randomized Clinical Trial

Interrater Reliability of a Tool Measuring the Quality of Nursing Triage in the Emergency Department

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