Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

Burström, Lena; Nordberg, M. E.; Örnung, Göran; Castrèn, Maaret; Wiklund, Tony; Engström, Marie-Louise; Enlund, Mats

doi:10.1186/1757-7241-20-57

Cited by 53 publications

(48 citation statements)

References 24 publications

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“…Triage errors are commonly ascribed to understaffing. Burstrom et al 's [7] study comparing three hospital triage systems found that a physician-led triage system resulted in improved efficiency and quality of patient care. Similarly, Molyneux et al [8] emphasised the need for well-trained nurses who are able to triage and assist in resuscitation, as this could increase treatment efficacy.…”

Section: Validity Of the Satsmentioning

confidence: 99%

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

et al. 2017

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Background. Triage in the emergency department (ED) is necessary to prioritise management according to the severity of a patient's condition. The South African Triage Scale (SATS) is a hospital-based triage tool that has been adopted by numerous EDs countrywide. Many factors can influence the outcome of a patient's triage result, and evaluation of performance is therefore pivotal. Objectives. To determine how often patients were allocated to the correct triage category and the extent to which they were incorrectly promoted or demoted, and to determine the main reasons for errors in a nurse-led triage system. Methods. Triage forms from a tertiary hospital ED in Gauteng Province, South Africa, were collected over a 1-week period and reviewed retrospectively. Results. A total of 1 091 triage forms were reviewed. Triage category allocations were correct 68.3% of the time. Of the incorrect category assignments, 44.4% of patients were promoted and 55.6% demoted. Patients in the green category were most commonly promoted (29.4%) and patients who should have been in orange were most commonly demoted (35.0%). Trauma patients were more likely to be incorrectly promoted and non-trauma patients to be incorrectly demoted. Mistakes were mainly due to discriminator errors (57.8%), followed by numerical miscalculations (21.5%). The leading omitted discriminators were 'abdominal pain' , 'chest pain' and 'shortness of breath' . Conclusions. Mis-triaging using the SATS can be attributed to incorrect or lack of discriminator use, numerical miscalculations and other human errors. Quality control and quality assurance measures must target training in these areas to minimise mis-triage in the ED.

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Section: Validity Of the Satsmentioning

confidence: 99%

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

et al. 2017

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“…In a study by Burström et al, [43] a comparison between triages of physicians and nurses between 8:00 and 21:00 was made; the team led by the physician had a greater advantage than the others in terms of activity and quality indications.…”

Section: Discussionmentioning

confidence: 99%

“…Studies about which of these health workers perform more accurate triage are insufficient. [40][41][42][43][44][45] Although ESI 5-level triage system has higher reliability and validity, it is unlikely to be routinely applied in the emergency departments of our country since it requires experience and education and, it is difficult to find a triage expert. Evaluation time is long in triage area and violent actions are made by patients who do not tolerate waits in overcrowded emergency departments (1.000 or more patients/day).…”

mentioning

confidence: 99%

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

Özüçelik¹,

Kunt²,

Karaca³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…This model used in adult and pediatric patients was associated with decreased length of stay in the ED, decreased rate of patients who left without treatment, decreased rate of patients who returned for an unscheduled visit, and decreased mortality within 7 days. 94 Rogg et al, 95 using a similar model, found a sustained improvement (over 3 years) in length of stay for all of their ED patients, whether they were actually seen by the physician-led triage team. They also saw a sustained improvement in the rate of patients leaving without being seen.…”

Section: Innovative Staffing Modelsmentioning

confidence: 99%

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

Barata¹,

Brown²,

Fitzmaurice³

et al. 2015

Pediatrics

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This report provides a summary of best practices for improving flow, reducing waiting times, and improving the quality of care of pediatric patients in the emergency department. CURRENT STATUS AND NEEDS ED Use and ED Crowding in the United StatesApproximately 800 000 children seek care in the emergency department (ED) each day in the United States. Additionally, it is estimated that 3.4% of US children use EDs as their source for sick care. The vast majority (92%) of these children are seen in community EDs, with a smaller percentage seen in pediatric EDs. The increase in ED utilization has saturated the capacity of EDs and emergency medical services in many communities. Increases in patient volume and decreases in resources, including fragmentation of resources and shortage of critical subspecialists, have resulted in EDs facing crowding and ambulance diversion.The need for emergency medical services outstrips the available resources on a daily basis. This mismatch is reflected by the considerable increase in the number of patients visiting EDs. In 1993, 90.3 million patients visited EDs; in 2003 that number increased to 113.9 million patients. Approximately 21% of these patients were younger than 15 years. Despite the increase in ED visits, the number of hospitals decreased by 703, the number of hospital beds decreased by 198 000, and the number of EDs decreased by 425.

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Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models

Cited by 53 publications

References 24 publications

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

The accuracy of nurse performance of the triage process in a tertiary hospital emergency department in Gauteng Province, South Africa

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

Best Practices for Improving Flow and Care of Pediatric Patients in the Emergency Department

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