Teaching Rapid Assessment Skills in Triage for the Emergency Medicine Clerkship

Rudolf, Frances; Oyama, Leslie C.; Schwartz, Kristy; Fernandez, Jorge; Hayden, Stephen R.

doi:10.1016/j.jemermed.2021.02.005

Cited by 3 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Triage is the first and perhaps most important part of emergency medicine. Rapid assessment of patients with unknown conditions and developing a gestalt for “sick or not sick” are core components of emergency medicine training 29,30 . Emergency physicians strive to prioritize patients and allocate limited medical resources through a valid triage system.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid assessment of patients with unknown conditions and developing a gestalt for "sick or not sick" are core components of emergency medicine training. 29,30 Emergency physicians strive to prioritize patients and allocate limited medical resources through a valid triage system. The TTAS is a computerized tool for triaging patients in the ED and was externally validated outside Taiwan 6 or in prehospital settings.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Physician gestalt for emergency department triage: A prospective videotaped study

Cheng

Sung

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

Objective: Appropriate triage in patients presenting to the emergency department (ED) is often challenging. Little is known about the role of physician gestalt in ED triage. We aimed to compare the accuracy of emergency physician gestalt against the currently used computerized triage process. Methods:We conducted a prospective observational study in the ED at an academic medical center. Adult patients aged ≥20 years were included and underwent a standard triage protocol. The patients underwent system-based triage using the computerized software the Taiwan Triage and Acuity Scale. The entire triage process was recorded, and triage data were collected. Five physician raters provided triage levels (physician-based) according to their perceived urgency after reviewing videos. The primary outcome was hospital admission. The secondary outcomes were ED length of stay (EDLOS) and charges.Results: In total, 656 patients were recruited (mean age 52 years, 50% male). The median system-based triage level was 3. By contrast, the median physician-based triage level was 4. The physician raters tended to provide lower triage levels than the system, with an average difference of 1. There was modest concordance between the two triage methods (correlation coefficient 0.30), with a weighted kappa coefficient of 0.18. The area under the receiver operating curve for the system-and physicianbased triage in predicting hospital admission were similar (0.635 vs. 0.631, p = 0.896).Attending physicians appeared to have better performance than residents in predicting admission. The variation explained (R 2 ) in EDLOS and charges were similar between the two triage methods (R 2 = 3% for EDLOS, 7%-9% for charges).Conclusions: Emergency physician gestalt for triage showed similar performance to a computerized system; however, physicians redistributed patients to lower triage levels. Physician gestalt has advantages for identifying low-risk patients. This approach may avoid undue time pressure for health care providers and promote rapid discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Physician gestalt for emergency department triage: A prospective videotaped study

Cheng

Sung

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…However, according to a report, the knowledge of triage nurses is often poor (9) while they need to have critical decision-making and thinking (10). Changing the methods of training to triage staff is recommended as providing direct observation and real-time feedback will be more effective (11).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Rapid Triage in Trauma Centers: A Qualitative Content Analysis

Monsef-Kasmaei

Zohrevandi

Bakerdar

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Although specialized trauma care in the triage unit can significantly increase the chances of survival of the injured, the obstacles to rapid triage are still a dilemma. Identifying these barriers is quite essential for effective clinical decision-making and improving positive outcomes. Objective This study aimed to report the experiences of the physicians and nurses regarding the obstacles to rapid triage. Method A qualitative study was performed on twenty physicians and nurses working in the triage unit of Poursina Hospital in northern Iran in 2021 using semi-structured interviews. The experiences were analyzed by the content analysis method. Credibility, reliability, and validity were used for data accuracy and trustworthiness. Sampling continued until data saturation. Results A total of 5 categories and 28 subcategories were obtained including the challenges related to employees, physical resource limitations, disruptions in the processes of triage, controlling and monitoring challenges, and specific characteristics of the referred patients. Conclusion Hospital authorities need to eliminate the barriers to rapid triage of patients which are related to education, experience, training, and retraining of triage staff. Physical resources in these units should increase and the triage processes need to improve by proper leveling of the patients and creating a triage view. The lack of coordination between the pre-hospital emergency team and the triage unit should be improved. Finally, the triage staff can strengthen the therapeutic interaction with agitated patients and caregivers.

show abstract

“Sick or not sick?” A mixed methods study evaluating the rapid determination of illness severity in a pediatric emergency department

et al. 2021

View full text Add to dashboard Cite

Objectives Experienced physicians must rapidly identify ill pediatric patients. We evaluated the ability of an illness rating score (IRS) to predict admission to a pediatric hospital and explored the underlying clinical reasoning of the gestalt assessment of illness. Methods We used mixed-methods to study pediatric emergency medicine physicians at an academic children’s hospital emergency department (ED). Physicians rated patients’ illness severity with the IRS, anchored by 0 (totally well) and 10 (critically ill), and shared their rationale with concurrent think-aloud responses. The association between IRS and need for hospitalization, respiratory support, parenteral antibiotics, and resuscitative intravenous (IV) fluids were analyzed with mixed effects linear regression. Area under the curve (AUC) receiver operator characteristic (ROC) curve and test characteristics at different cut-points were calculated for IRS as a predictor of admission. Think-aloud responses were qualitatively analyzed via inductive process. Results A total of 141 IRS were analyzed (mean 3.56, SD 2.30, range 0–9). Mean IRS were significantly higher for patients requiring admission (4.32 vs. 3.13, p<0.001), respiratory support (6.15 vs. 3.98, p = 0.033), IV fluids (4.53 vs. 3.14, p < 0.001), and parenteral antibiotics (4.68 vs. 3.32, p = 0.009). AUC for IRS as a predictor of admission was 0.635 (95% CI: 0.534–0.737). Analysis of 95 think-aloud responses yielded eight categories that describe the underlying clinical reasoning. Conclusions Rapid assessments as captured by the IRS differentiated pediatric patients who required admission and medical interventions. Think-aloud responses for the rationale for rapid assessments may form the basis for teaching the skill of identifying ill pediatric patients.

show abstract

Teaching Rapid Assessment Skills in Triage for the Emergency Medicine Clerkship

Cited by 3 publications

References 9 publications

Physician gestalt for emergency department triage: A prospective videotaped study

Physician gestalt for emergency department triage: A prospective videotaped study

Barriers to Rapid Triage in Trauma Centers: A Qualitative Content Analysis

“Sick or not sick?” A mixed methods study evaluating the rapid determination of illness severity in a pediatric emergency department

Contact Info

Product

Resources

About