Walking in – Initial visualisation and assessment at triage

Edwards, Bernie

doi:10.1016/j.aaen.2006.12.008

Cited by 17 publications

(16 citation statements)

References 17 publications

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“…CTAS education and staff turnover did not appear to influence results over time on reliability, rates of insufficient data, and inconsistent triage. Our study may reflect the level of reliability and performance accuracy expected without a persistent, structured effort to improve proficiency [9–12]. Without a more intensive audit and feedback system CTAS performance remained static.…”

Section: Discussionmentioning

confidence: 89%

A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

Howlett

Atkinson

2012

Emergency Medicine International

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Objectives. Triage data are widely used to evaluate patient flow, disease severity, and emergency department (ED) workload, factors used in ED crowding evaluation and management. We defined an indicator-based methodology that can be easily used to review the accuracy of Canadian Triage and Acuity Scale (CTAS) performance. Methods. A trained nurse reviewer (NR) retrospectively triaged two separate month's ED charts relative to a set of clinical indicators based on CTAS Chief Complaints. Interobserver reliability and accuracy were compared using Kappa and comparative statistics. Results. There were 2838 patients in Trial 1 and 3091 in Trial 2. The rate of inconsistent triage was 14% and 16% (Kappa 0.596 and 0.604). Clinical Indicators “pain scale, chest pain, musculoskeletal injury, respiratory illness, and headache” captured 68% and 62% of visits. Conclusions. We have demonstrated a system to measure the levels of process accuracy and reliability for triage over time. We identified five key clinical indicators which captured over 60% of visits. A simple method for quality review uses a small set of indicators, capturing a majority of cases. Performance consistency and data collection using indicators may be important areas to direct training efforts.

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Section: Discussionmentioning

confidence: 89%

A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

Howlett

Atkinson

2012

Emergency Medicine International

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“…Favorable results in many studies may be suspect because of the use of simulated case presentations (often desk-top) [16,17], a method that may not translate to the ED triage desk, as so much of a triage assessment is based on direct observation of the patient [18]. Of the four five-level triage systems in widespread use around the world, CTAS has been one of the most extensively studied.…”

Section: Discussionmentioning

confidence: 99%

A comparison of a formal triage scoring system and a quick-look triage approach

Betz

Stempien

Wilde³

et al. 2016

European Journal of Emergency Medicine

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“…This process may start before words are spoken, and the clinician’s perceptions may change as the visit progresses 4–6. In an acute care setting where triage and presumptive diagnosis are especially important, the most significant initial observations are the degree to which the patient appears to be suffering from physical or emotional distress and whether the patient appears acutely ill, chronically ill, neither, or both 7–9. Other observations that might affect the doctor–patient interaction and accuracy of the history include whether the patient seems alert or confused, cooperative or oppositional, and if grooming seems appropriate for the circumstance 1,5…”

Section: Discussionmentioning

confidence: 99%

<div>Communication pitfalls of traditional history and physical write-up documentation</div>

Brown

2016

AMEP

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BackgroundAn unofficial standardized “write-up” outline is commonly used for documenting history and physical examinations, giving oral presentations, and teaching clinical skills. Despite general acceptance, there is an apparent discrepancy between the way clinical encounters are conducted and how they are documented.MethodsFifteen medical school websites were randomly selected from search-engine generated lists. One example of a history and physical write-up from each of six sites, one teaching outline from each of nine additional sites, and recommendations for documentation made in two commonly used textbooks were compared for similarities and differences.ResultsExcept for minor variations in documenting background information, all sampled materials utilized the same standardized format. When the examiners’ early perceptions of the patients’ degree of illness or level of distress were described, they were categorized as “general appearance” within the physical findings. Contrary to clinical practice, none of the examples or recommendations documented these early perceptions before chief concerns and history were presented.DiscussionAn examiner’s initial perceptions of a patient’s affect, degree of illness, and level of distress can influence the content of the history, triage decisions, and prioritization of likely diagnoses. When chief concerns and history are shared without benefit of this information, erroneous assumptions and miscommunications can result.ConclusionThis survey confirms common use of a standardized outline for documenting, communicating, and teaching history-taking and physical examination protocol. The present outline shares early observations out of clinical sequence and may provide inadequate context for accurate interpretation of chief concerns and history. Corrective actions include modifying the documentation sequence to conform to clinical practice and teaching contextual methodology for sharing patient information.

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Walking in – Initial visualisation and assessment at triage

Cited by 17 publications

References 17 publications

A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

A Method for Reviewing the Accuracy and Reliability of a Five-Level Triage Process (Canadian Triage and Acuity Scale) in a Community Emergency Department Setting: Building the Crowding Measurement Infrastructure

A comparison of a formal triage scoring system and a quick-look triage approach

<div>Communication pitfalls of traditional history and physical write-up documentation</div>

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