Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Triage”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources
PubMed2006

The use of the Soterion Rapid Triage System in children presenting to the Emergency Department.

There has been a recent move toward the adoption of five-level triage systems in the United States. However, there have been no studies in this country that have critically evaluated the use of these systems in children. The purpose of this study was to evaluate the reliability and validity of a new five-level triage system, the Soterion Rapid Triage System, for stratifying acuity levels in children under the age of 13 years. The study was conducted in a 389-bed Level II mixed adult and pediatric Trauma Center that experiences approximately 12,000 patient visits/year of children under the age of 13 years. We performed a prospective evaluation of the system's reliability using the weighted kappa statistical method (n = 117) and a retrospective evaluation of the system's validity through an analysis of all patients under the age of 13 years triaged with the system over an 8-month period (n = 7077). The system's validity was measured by in-hospital admission rate, Emergency Department length of stay, hospital charges, and Current Procedural Terminology (CPT) Codes 99281-99285. The inter-rater reliability as measured by the weighted kappa was 0.90 (95% confidence interval 0.83-0.96), with 92% exact agreement between nurses in the triage level assigned. The in-hospital admission rates for patients triaged as Level 1 Immediate-Level 5 Non-Urgent were 38%, 18%, 9%, 1.5% and 0.4%, respectively (p < 0.0001). The mean total hospital charges for each of the five triage levels were $2673, $1563, $1112, $477, and $258, respectively (p < 0.0001). Similarly, there were significant differences in the means for laboratory and pharmacy charges, Emergency Department lengths of stay, and CPT Codes. This report represents the first study in this country on the effectiveness of a five-level triage system in children. We have demonstrated that the Soterion Rapid Triage System possesses high inter-rater reliability and validity when used to triage children younger than 13 years of age.

Algorithms↗
PubMed1997

Does a physician visual assessment change triage?

A prospective comparative trial was conducted to determine the effect of a physician's visual assessment of emergency patients on triage categorization and ability at triage to predict admission. The setting was a university, county, referral center and residency training site. Participants were a consecutive sample of emergency department patients presenting between the times of 0700 and 2300 hours for 5 weeks. All patients were assigned a triage category by an emergency nurse (RN) who saw the patient and by an emergency physician (EP) who had the option of performing a visual assessment. Triage categorization was compared for interobserver agreement (Kappa [kappa] statistic) and by ability to predict admission (MacNemar's test). A total of 3,949 patients was entered. The patients that physicians visually assessed were triaged by nurses as more ill (P < .001). For triage categories visualized by the EP compared with RN categorization, interobserver agreement was 59.8%, kappa = .21. For triage categories not visualized by EP compared with RN categorization, interobserver agreement was 67.9%, kappa = .45 (P < .001). Sensitivity of EPs to predict admission is as follows: all RN triage, 41.3; not seen by EP, 54.9; seen by EP, 69.3. Specificity is as follows: all RN triage, 93.7; not seen by EP, 88.5, seen by EP, 83.9. When physician visual assessment was done, agreement between physicians and nurses decreased by more than half. Physicians who included visual assessment in patient triage were less likely to agree with RN categorization. A visual assessment by the physician improved the sensitivity for predicting admission with an only small cost in specificity.

Clinical Competence↗
PubMed1999

Triage decision making: educational strategies.

Patient triage in Accident and Emergency departments requires emergency nurses to make rapid decisions based on their knowledge and experiences. The development of triage decision-making skills can be addressed through the use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced emergency nurses. Clinical educators and experienced emergency nurse mentors are encouraged to recognize that skill acquisition in triage decision making requires practice before registered nurses can engage fully in the process of triaging patients in the emergency department. It is essential to experience the process of triage decision making in order to develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information leading to a decision on the triage category for each patient. By using triage simulations developed from 'real triage cases' the process of decision making can be experienced by nurses. Further, if these simulations are accompanied by the collection of verbal protocols, nurses have opportunities retrospectively to explore their decision making with reflection. In addition, the presentation and use of decision rules used by experienced triage nurses can enhance the development of skills in novice triage nurses.

Clinical Competence↗
PubMed2003

Interobserver agreement in emergency department triage.

STUDY OBJECTIVES: We measure the interobserver reliability of the triage process, examine the effect of vital signs on the triage process, and provide a context for the prior observation of poor interobserver agreement between in-person and telephonic interviews. METHODS: We performed a prospective observational study using a randomized crossover design at a university teaching hospital emergency department. Patients were eligible if they spoke English, were not presenting for a reevaluation, and were unlikely to be harmed by the delay created by a second triage interview. Every eligible patient underwent 2 independent, sequential, in-person ED intake interviews conducted by experienced ED triage nurses. After taking a history, each nurse chose 1 of 5 hypothetic triage designations (ED by 911, ED within 2 hours, see a physician within 8 hours, see a physician within 24 hours, or home care-see a physician in >24 hours) and, after being told the patient's vital signs, again selected a designation. RESULTS: Three hundred sixty-three patients presented during the study period: 113 were ineligible, 34 were missed by the investigators, and 15 refused to participate. Nineteen nurses participated in the triage of the 201 study patients. Agreement between 2 in-person designations made without knowledge of vital signs was poor (percent agreement 53%; kappa=0.30; tau(b)=0.50). Knowledge of vital signs did not improve agreement (percent agreement 49%; kappa=0.25; tau(b)=0.45). CONCLUSION: There was poor interobserver agreement between certified triage nurses using a 5-item triage scale designed for telephonic triage. These findings suggest that only a small portion of the poor interobserver agreement observed in a prior study of telephonic versus in-person triage can be attributed to the use of the telephone.

Cross-Over Studies↗
PubMed1996

Improved pediatric patient flow in a general emergency department by altering triage criteria.

OBJECTIVE: To evaluate the effect of altering pediatric triage criteria on ED triage scoring and patient flow. METHODS: A prospective observational study of a pediatric triage modification was performed. Data for all pediatric patients presenting to an urban general ED during a six-month study period were collected. After the first three months, pediatric triage criteria were altered by elevating the acuity of several historical items and specifically listing abnormal signs and symptoms. Outcome measures included triage score assignment, criteria making the patient emergent, proportion of emergent or urgent triage assignments, and times to examination, disposition, and admission. RESULTS: Altering pediatric triage criteria resulted in a significant (p < 0.05) increase in the number of patients triaged as emergent (2% vs 15%) or urgent (48% vs 55%). In addition, for emergent and urgent patients there was a significant decrease (p < 0.05) in the mean times to ED examination (50 vs 44 min), floor admission (355 vs 245 min), and intensive care unit admission (221 vs 132 min). The triage changes that had a significant impact on these results were a history of color change, decreased activity, and prematurity with complications. CONCLUSIONS: A significant improvement in pediatric patient flow occurred after posting age-specific abnormal signs and symptoms as well as elevating triage acuity for specific historical clues.

Child↗
PubMed2000

Reliability and validity of a new five-level triage instrument.

OBJECTIVES: Triage is the initial clinical sorting process in hospital emergency departments (EDs). Because of poor reproducibility and validity of three-level triage, the authors developed and validated a new five-level triage instrument, the Emergency Severity Index (ESI). The study objectives were: 1) to validate the triage instrument against ED patients' clinical resource and hospitalization needs, and 2) to measure the interrater reliability (reproducibility) of the instrument. METHODS: This was a prospective, observational cohort study of a population-based convenience sample of adult patients triaged during 100 hours at two urban referral hospitals. Validation by resource use and hospitalization (criterion standards) and reproducibility by blinded paired triage assignments compared with weighted kappa analysis were assessed. RESULTS: Five hundred thirty-eight patients were enrolled; 45 were excluded due to incomplete evaluations. The resulting cohort of 493 patients was 52% female, was 26% nonwhite, and had a median age of 40 years (range 16-95); overall, 159 (32%) patients were hospitalized. Weighted kappa for triage assignment was 0.80 (95% CI = 0.76 to 0.84). Resource use and hospitalization rates were strongly associated with triage level. For patients in category 5, only one-fourth (17/67) required any diagnostic test or procedure, and none were hospitalized (upper confidence limit, 5%). Conversely, in category 1, one of twelve patients was discharged (upper confidence limit, 25%), and none required fewer than two resources. CONCLUSIONS: This five-level triage instrument was shown to be both valid and reliable in the authors' practice settings. It reproducibly triages patients into five distinct strata, from very high hospitalization/resource intensity to very low hospitalization/resource intensity.

Adolescent↗
PubMed2002

Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs.

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. PARTICIPANTS: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference pound 1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments.

Appointments and Schedules↗
PubMed2004

Triage of the pediatric patient in the emergency department: are we all in agreement?

OBJECTIVE: To compare triage categorization as a measure of perceived patient acuity on presentation to the emergency department by pediatric emergency medicine (PEM) attending physicians, nurses, and pediatric residents with their general emergency medicine (GEM) counterparts. METHODS: A questionnaire that contained 12 pediatric triage scenarios was sent to all PEM attending physicians, triage-trained nurses, and pediatric residents and their GEM counterparts at a large urban hospital with separate pediatric and general emergency departments. Participants were asked to use a 3-tier triage system (emergent, urgent, nonurgent) to assign a triage level for each patient scenario. RESULTS: The response rate was 99%. The kappa level of agreement was highest (.39) among the PEM physicians. Significantly more GEM attending physicians triaged the following scenarios at a higher acuity level as compared with PEM attending physicians with a trend toward emergent triage: simple febrile seizure, 50% (95% confidence interval [CI]: 30%-70%) versus 7.7% (95% CI: 1%-34%); 18-month-old with fever and bumps on lips, 21% (95% CI: 9%-43%) versus 0% (95% CI: 0%-23%); and 15-month-old well-appearing child with high fever, 50% (95% CI: 30%-70%) versus 7.7% (95% CI: 1%-34%). Significant differences were found between GEM and PEM triage-trained nurses only in the 15-month-old high fever scenario and between GEM and pediatric residents in the 15-month-old high fever scenario, the 18-month-old with fever and bumps on lips scenario, and a fever/limp scenario. CONCLUSIONS: The level of agreement of triage assignment within each group was only fair. GEM participants and PEM participants agreed on most scenarios. However, GEM participants were more likely to triage children with certain febrile illnesses at higher acuity levels as compared with their PEM counterparts.

Emergency Medicine↗
PubMed1994

An observational study of the emergency triage nursing role in a managed care facility.

Introduction A 72-hour observational pilot study was conducted at a large managed-care facility to determine what functions triage nurses fulfilled, how often they fulfilled these functions, and how much time was taken for these functions. Methods Patient arrival times, nursing activities, and patient dispositions were recorded. Activities were classified as either primary or nonprimary, according to defined triage purposes. Two alternating observers collected data continuously for 72 hours, during which they observed 13 triage nurses as they completed their regularly scheduled shifts. All nonprimary functions that occurred while the triage nurses fulfilled primary functions were classified as interruptions. All data were entered into computer software and whole minutes were used for calculating times. Results Nurses provided triage for 466 patients, and 655 telephone calls occurred. Twenty-nine physical triage activities and 26 telephone activities were observed. Telephone functions occupied about 22% of the time. Nonprimary telephone or triage functions interrupted 251 (54%) of all patients who were seen for triage. These interruptions notably increased pretriage waiting times for all patients who were interrupted but were most significant for patients with acuity levels 2 (p < 0.05) and 3 (p < 0.05). Number of interruptions and length of time spent waiting to see the triage nurses were significantly correlated (r = 0.69). Discussion Our study describes a method of evaluating triage nursing activities and suggests that some functions may contribute to delays in physician and nurse access.

Clinical Nursing Research↗
PubMed1993

A statistical model validating triage for the peer review process: keeping the competitive applications in the review pipeline.

Triage of grant application at the National Institutes of Health (NIH) is a process whereby an initial screening of applications by a scientific peer review group eliminates applications that are not competitive for awards. The process of application triage has been limited to those applications submitted to the NIH in response to an RFA (Request for Applications). A hypergeometric model was developed to determine the extent to which five, six, seven, or eight member triage teams or subsets of 12-to-20 member full committees could provide a statistically defensible triage decision. Although the intent of triage is to remove from review those applications that are noncompetitive, the model was weighted in favor of the applicant to minimize the likelihood that highly competitive applications would be eliminated. Within the assumptions and rules developed, it was determined that there was little likelihood that the latter would occur. For example, in the worst case scenario, the greatest probability that a highly competitive application would be knocked out of competition is P < or = 0.014 in the case of a five-member triage subset of a 20-member committee. Using the latter case, the model was tested on a set of 73 applications that were submitted to the National Cancer Institute for action at the February 1993 National Cancer Advisory Board. The model selected for triage required that each application be assigned to five reviewers, that each reviewer be blinded to the review assignments of the other reviewers, and that four noncompetitive votes be registered to triage out an application. Each of 19 applications received four to five noncompetitive votes, and were triaged out of the review process. The remaining 54 applications were then reviewed according to the usual NIH review process. Four of the applications received three noncompetitive triage votes each and were either rated as not recommended for further consideration (NRF, n = 2)) or received priority scores > or = 250 (n = 2) (The smaller the priority score the better the technical merit). Thirteen of the 53 applications received two noncompetitive votes. Of the latter, two were not recommended for further consideration and the remaining 11 received priority scores between in excess of 200. The distribution of competitive applications was such that funding was limited to those applications with priority scores of less than 190. Thus, the data suggest that the conservative model is valid such that the likelihood of eliminating a highly competitive application from consideration for funding is remotely small.(ABSTRACT TRUNCATED AT 400 WORDS)

Competitive Bidding↗
PubMedDate not supplied

Garden path repair: diagnosis and triage.

Meng and Bader (2000b) have shown that for garden-path repair in German, case is a more effective cue than number. They argue that sensitivity to the nature of the cue supports a diagnosis model of garden path repair such as we have proposed. However, in making this argument Meng and Bader introduced a new notion of diagnosis. Retaining the original "basic" diagnosis system, they added a new function that we call triage. Triage determines the probable revisability of a structure, in order to decide whether to make the effort of trying to reanalyze it. To determine whether triage is a feature of human parsing, its scope must be established. We compare four hypotheses about how much work triage could do. A powerful triage component would succeed where the human parser fails. Limited local triage does no work if symptom effectiveness varies within a language. An intermediate hypothesis discriminates better between easy and difficult revisions. However, this variant of triage with the strongest claim to psychological reality is the most difficult to distinguish from no triage at all, since it shares important properties with basic diagnosis. We identify some empirical predictions that differentiate diagnosis with triage from simple basic diagnosis. What little evidence there is at present suggests that the human sentence parser has no triage capability.

Cues↗
PubMed2003

[Clinical evaluation of triage as drug-of-abuse test kit].

There are about 60,000 chemical substances which may cause poisoning. Identifying the cause substances is, therefore, very important for patient at emergency department. Triage is an immunoassay kit for the qualitative test for the metabolites of 8 major abuse drugs in urine. We assessed the usefullness of Triage on two patient groups. The first Group consists of the patients considered having not taken substances at initial diagnosis; the second Group consists of the patients considered having taken substances. The result are as follows. 1) The rate of Triage positive patients in the first Group were: attempt-suicide 23%, coma 24%, shock 10%, trauma 7%, respectively. Except for the habitually used medicine, narcotic and stimulant drugs were detected. In the first Group, negative result of Triage was effective in diagnosing the patients as not poisoned, excluding the possitivity of 8 major drugs usage. 2) The rate of Triage positive patients in the second Group were very high: attempt-suicide 77%, coma 51%, shock 57%, trauma 30%, respectively, showing mostly any of 8 major drugs were the cause of poisoning. In the second Group, positive result of Triage was effective in diagnosing the patient as poisoning or as coexisting poisoning with other diseases. 3) The specificity of Triage diagnosis in the first Group was 80% (113/142). The specificity and the sensitivity in the second Group were 64% (50/78) and 97% (74/76), respectively. These results means that Triage is very useful for diagnosis on 8 major drugs poisoning. 4) Triage is efficient for identifying the cause substances in drug poisoning and, therefore, can save medical expense. Triage is a very useful test kit at emergency department.

Anti-Anxiety Agents↗
PubMed1993

Expediting the early hospital care of the adult patient with nontraumatic chest pain: impact of a modified ED triage protocol.

A prospective study that compared a traditional emergency department (ED) triage protocol with an expedited protocol was conducted to determine if minimizing the subjectivity of nursing triage would result in more efficient management of adult patients presenting with nontraumatic chest pain. The traditional protocol triaged 382 patients into 1 of 5 categories of acuity. The expedited study group (418 patients) were triaged as usual but subsequently were treated as if they were triage category 1 or 2 (medical evaluation within 15 minutes of arrival). Traditional triage led to 40% of acute myocardial infarction (AMI) patients being triaged into inappropriately low-acuity categories. The expedited protocol resulted in significant improvement in the following intervals: ED arrival to triage, triage to cubicle, ED arrival to cubicle, ED arrival to electrocardiogram (ECG) ordered, ED arrival to ECG available, ED arrival to physician evaluation, and ED arrival to decision to thrombolyse. Study patients with non-AMI cardiac chest pain and AMI cardiac chest pain were evaluated by a physician an average of 12 minutes and 8 minutes after ED arrival, respectively. Delays in interdepartmental processes, such as ECG-technician responsiveness, thrombolysis protocol fulfillment and thrombolytic agent delivery, negated benefits derived from improvements in internal processes. Effective coordination of the numerous processes involved in the initial ED management of adult patients with nontraumatic chest pain is required to make thrombolytic therapy for AMI within 30 minutes of patient arrival a routinely achievable goal.

Adult↗
PubMed2005

An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes.

INTRODUCTION: The role of the triage nurse has emerged in response to growing community demand for a more accessible and efficient emergency department (ED) service. The focus of triage research has been on measuring outcomes and improving the delivery of emergency care. This has meant that the context of care, and triage processes and practices have remained concealed. Thus, little evidence about the role and ways to prepare nurses for this role is available. The aim of this study was to provide insight and understanding needed to educate and support the triage nursing role in Australian EDs. METHODS: A 12-month ethnographic study of triage nursing practice was conducted in Sydney metropolitan EDs. Data were then collected from participant observation in four EDs and interviews with 10 triage nurses. Analysis used standard content and thematic analysis techniques. FINDINGS: Findings reveal that notions of timeliness, efficiency and equity are embedded in a culture of ED care. This sustains a particular cadence of care to which triage nurses are culturally oriented. Triage nurses maintain, negotiate and restore this cadence of emergency care by using gatekeeping, timekeeping and decision-making processes. CONCLUSION: The comprehensive study of triage nursing has led to the development of an educational framework based on the processes of gatekeeping, timekeeping and decision-making.

Anthropology, Cultural↗
PubMed1992

Trauma triage: a nine-year experience.

STUDY OBJECTIVE: To describe the Orange County trauma system's nine-year (July 1980 through June 1989) experience with patient triage. Changes in patterns were sought after the 1983 revisions in triage criteria. DESIGN: A nine-year retrospective analysis of trends in trauma patient triage in Orange County. A pre-analysis and postanalysis to discern changes in trends after a July 1983 revision in triage criteria was conducted. SETTING: Orange County, California, Emergency Medical Services (EMS) Agency, serving an urban population of more than 2 million. Orange County EMS responds to about 90,000 calls annually, 3,500 of which are for trauma patients. Twenty-eight nontrauma and neurosurgical paramedic receiving centers and four paramedic trauma receiving centers served the community during the study period. TYPE OF PARTICIPANTS: All patients triaged to Orange County trauma centers between July 1980 and June 1989. Single neurologic injury patients were triaged to neurosurgical receiving centers and are not included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Logarithmic regression analysis showed a 386% increase in the number of trauma patients triaged to trauma centers. The number of more seriously injured patients, as estimated by length of hospital stay of more than four days; Injury Severity Score of more than 15; fatality; or patients requiring surgery within six hours for trauma to the chest, abdomen, central nervous system, and/or major vessel, also increased. The rates of increase were more than those of the population (15%) for the Injury Severity Score of more than 15 group (79%) and the length of stay of more than four days group (108%), but lower for the fatality group (11%) and the early surgery group (7%). Because traffic and motor vehicle accidents comprise 70% to 80% of all trauma injuries, a separate analysis was conducted for these cases, using numbers of miles traveled as a basis for analysis. The analysis revealed a significant (alpha = .05) increase in over-triage rate, from 43% in 1981 to 74% in 1988, for motor vehicle accident patients. No changes in trends were found in the pre-analysis and postanalysis. Changes in trends occurred in 1986. CONCLUSION: The growth rate for the total trauma population exceeds that for overall county population growth. These results suggest overtriage. No changes in trends were found after the 1983 revisions in triage criteria. Changes in trends were found in 1986 after the revisions in the Injury Severity Score scoring system.

California↗
PubMed2002

Development of physiological discriminators for the Australasian Triage Scale.

The Consistency of Triage in Victoria's Emergency Departments Project (2001), funded by the Victorian Department of Human Services, aimed to improve the consistency of application of the Australasian (National) Triage Scale (ATS). One of the major objectives of the project was the development of an education strategy to promote a consistent approach to triage education, leading to the development of the Adult Physiological Discriminators (APDs) for the ATS and Paediatric Physiological Discriminators (PPDs) for the ATS. The guidelines and physiological discriminators were developed in consultation with the Emergency Nurses' Association of Victoria (ENA Vic.) and clinical nurse educators, lecturers, nurse unit managers and clinicians from a wide variety of Emergency Departments (EDs) across Victoria. Numerous studies have identified varying degrees of inconsistency in the application of the ATS. A number of factors associated with inconsistency in the application of the ATS have also been alluded to in the literature. These range from the wide variation in the experiential and educational requirements of Victorian triage nurses to the specific clinical characteristics of the patient identified by the triage nurse. However, a consistent approach to triage education and uniform triage guidelines has been repeatedly identified as a key factor in improving the consistency of application of the ATS. Physiological data demonstrates the highest degree of objectivity and consistency and research has shown that physiological observations are useful and measurable indicators of clinical urgency and patient safety. This paper will discuss the development of these discriminators as part of the educational strategy including a critique of other approaches to triage decision-making and a review of the consultative processes used to facilitate consensus amongst triage nurses, ED Nurse Managers and ED Nurse Educators. The physiological discriminators developed by this project are also presented.

Adult↗
PubMed2002

An advance triage system.

This paper describes the redesign of the triage process in an Emergency Department with the purpose of improving the patient flow and thus increasing patient satisfaction through the reduction of the overall length of stay. The process, Advance Triage, allows the triage nurse to initiate diagnostic protocols for frequently occurring medical problems based on physician-approved algorithms. With staff and physician involvement and medical specialist approval, nine Advance Triage algorithms were developed-abdominal pain, eye trauma, chest pain, gynaecological symptoms, substance abuse, orthopaedic trauma, minor trauma, paediatric fever and paediatric emergent. A comprehensive educational program was provided to the triage nurses and Advance Triage was initiated. A process was established at one year to evaluate the effectiveness of the Advance Triage System. The average length of stay was found to be 46 min less for all patients who were advance triaged with the greatest time-saving of 76 min for patients in the 'Urgent' category. The most significant saving was realized in the patient's length of stay (LOS) after the Emergency Physician assessed them because diagnostic results, available during the initial patient assessment, allowed treatment decisions to be made at that time. Advance Triage utilizes patient waiting time efficiently and increases the nurses' and physicians' job satisfaction.

Algorithms↗
PubMed2002

Five-level triage system more effective than three-level in tertiary emergency department.

INTRODUCTION: The study objectives were to compare reliability and validity of a 3-level (3L) triage system with a new 5-level (5L) triage system and determine the effect of nursing experience on triage reliability. METHODS: The study was conducted in a southeastern tertiary emergency department. With a stratified random sample, reliability of 3L triage ratings was measured with weighted kappa (time 1). The 5L system was then implemented, and weighted kappa was remeasured (time 2). Validity was assessed by comparing case mix, sensitivity, and specificity at times 1 and 2, and comparing 5L ratings with physician billing (Evaluation and Management) codes and nursing resource intensity at time 2. RESULTS: Time 1 case mix (15,324 patients) was: level 1, 6%; level 2, 36%; level 3, 59%, and time 2 (16,024 patients) was: level 1, 1%; level 2, 8%; level 3, 38%; level 4, 41%; level 5, 13%. Three hundred-five triage ratings were evaluated from time 1, and 303 were evaluated from time 2. Weighted kappa was 0.53 for time 1 and 0.68 for time 2. Spearman correlations were: 5L and nursing resource intensity, 0.55 (P <.0001); and 5L and Em, 0.57 (P <.0001). Sensitivity was 58% for the 3L and 68% for the 5L. Specificity was 83% for the 3L and 91% for the 5L. Under-triage rates were 28% for the 3L and 12% for the 5L, and less-experienced nurses were more likely to under-triage using the 3L system. DISCUSSION: The 5L triage system is safer and provides greater discrimination, better reliability, and improved sensitivity and specificity than the 3L triage system.

Diagnosis-Related Groups↗