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At least 19 recordsLinked to original sources
PubMed1999

An Australian mass casualty incident triage system for the future based upon triage mistakes of the past: the Homebush Triage Standard.

BACKGROUND: The purpose of this study was to create a system of mass casualty incident triage that provides a common language platform for both ambulance and hospital personnel based upon standard daily operating procedures for both groups. METHODS: An annotated literature review was conducted. RESULTS: The Homebush Triage Standard taxonomy consists of five categories: immediate, urgent, not urgent, dying and dead, which are given the phonetic alphabet designations of Alpha, Bravo, Charlie, Delta and Echo, respectively, to facilitate radio voice communications. Colours are assigned to each category: red (Homebush Red), yellow (Homebush Gold), green (Homebush Green), white and black comply with Standards Australia AS-2700 1996 Colour Standard for General Purposes, to ensure triage materials have consistent production standards. Numbers are reserved to either quantify or stratify individuals within a particular triage category. The Homebush Triage Standard methodology is based on START (Simple Triage Assessment and Rapid Transport) and SAVE (Secondary Assessment of Victim Endpoint) and documents triage priority using geographic triage with triage flags, instead of triage tags. CONCLUSION: The Homebush Triage Standard provides a basis for both seamless patient reassessment at all points along the casualty evacuation chain and the audit of the medical response to mass casualty incidents. It allows hospital and ambulance staff to keep working using familiar routines and removes fundamental barriers to good communication during a time of crisis.

Australia↗
PubMed2005

Emergency triage: comparing a novel computer triage program with standard triage.

BACKGROUND: Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed. OBJECTIVES: To determine the agreement between a computer decision tool and memory-based triage. METHODS: Consecutive patients presenting to a large, urban, tertiary care ED were assessed in the usual fashion and by a blinded study nurse using a computerized decision support tool. Triage score distribution and agreement between the two triage methods were reported. A random subset of patients was selected and reviewed by a blinded expert panel as a consensus standard. RESULTS: Over five weeks, 722 ED patients were assessed; complete data were available from 693 (96%) score pairs. Agreement between the two methods was poor (kappa = 0.202; 95% confidence interval [95% CI] = 0.150 to 0.254); however, agreement improved when using weighted kappa (0.360; 95% CI = 0.305 to 0.415) or "within one" level kappa (0.732; 95% CI = 0.644 to 0.821). When compared with the expert panel, the nurse triage scores showed lower agreement (0.263; 95% CI = 0.133 to 0.394) than the tool (kappa = 0.426; 95% CI = 0.289 to 0.564). There was a significant down-triaging of patients when patients were triaged without the computerized tool. Admission rates also differed between the triage systems. CONCLUSIONS: There was significant discrepancy by nurses using memory-based triage when compared with a computer tool. Triage decision support tools can mitigate this drift, which has administrative implications for EDs.

Canada↗
PubMedDate not supplied

Impact on patients triage distribution utilizing the Australasian Triage Scale compared with its predecessor the National Triage Scale.

OBJECTIVE: To assess the impact of the change from the National Triage Scale (NTS) to the Australasian Triage Scale (ATS) within a hospital ED. METHODS: A retrospective audit of consecutive adult patients attending the ED of Auckland Hospital from July to September 2001, during which patients were triaged according to the NTS, were compared with patients triaged according to the ATS during July to September 2002. RESULTS: In total, 8715 patients attended the department during July to September 2001 compared with 9047 patients during July to September 2002. There was a significant shift in the triage ratios with patient number increases of 28 and 24% in triage categories two and three, respectively, and decreases of 15 and 67% in categories four and five, respectively. CONCLUSIONS: The revision of the ATS has had a significant impact on the triage distribution of patients who present to ED. The change of distribution might have implications for meeting performance criteria and assessing casemix.

Adult↗
PubMed2006

The Cape Triage Score: a new triage system South Africa. Proposal from the Cape Triage Group.

The Cape Triage Group (CTG) convened with the intention of producing a triage system for the Western Cape, and eventually South Africa. The group includes in-hospital and prehospital staff from varied backgrounds. The CTG triage protocol is termed the Cape Triage Score (CTG), and has been developed by a multi-disciplinary panel, through best available evidence and expert opinion. The CTS has been validated in several studies, and was launched across the Western Cape on 1 January 2006. The CTG would value feedback from readers of this journal, as part of the ongoing monitoring and evaluation process.

Attitude of Health Personnel↗
PubMedDate not supplied

Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake.

Triage of mass casualties in situations in which patients must remain on-scene for prolonged periods of time, such as after a catastrophic earthquake, differs from traditional triage. Often there are multiple scenes (sectors), and the infrastructure is damaged. Available medical resources are limited, and the time to definitive care is uncertain. Early evacuation is not possible, and local initial responders cannot expect significant outside assistance for at least 49-72 hours. Current triage systems are based either on a shorter time to definitive care or on a longer time to initial triage. The Medical Disaster Response (MDR) project deals with the scenario in which specially trained, local health-care providers evaluate patients immediately after the event, but cannot evacuate patients to definitive care. For this type of scenario, a dynamic triage methodology was developed that permits the triage process to evolve over hours or even days, thereby maximizing patient survival and resulting in a more efficient use of resources. This MDR system incorporates a modified version of "Simple Triage and Rapid Treatment" (START) that substitutes radial pulse for capillary refill, coupled with a system of secondary triage termed, "Secondary Assessment of Victim Endpoint" (SAVE). The SAVE triage was developed to direct limited resources to the subgroup of patients expected to benefit most from their use. The SAVE assesses survivability of patients with various injuries and, on the basis of trauma statistics, uses this information to describe the relationship between expected benefits and resources consumed. Because early transport to an intact medical system is unavailable, this information guides treatment priorities in the field to a level beyond the scope of the START methodology. Pre-existing disease and age are factored into the triage decisions. An elderly patient with burns to 70% of body surface area is unsalvageable under austere field conditions and would require the use of significant medical resources-both personnel and equipment-and would be triaged to an "expectant area." Conversely, a young adult with a Glasgow Coma Scale score of 12 who requires only airway maintenance would use few resources and would have a reasonable chance for survival with the interventions available in the field, and would be triaged to a "treatment" area. The START and SAVE triage techniques are used in situations in which triage is dynamic, occurs over many hours to days, and only limited, austere, field, advanced life support equipment is readily available. The MDR-SAVE methodology is the first systematic attempt to use triage as a tool to maximize patient benefit in the immediate aftermath of a catastrophic disaster.

Abdominal Injuries↗
PubMed2006

Interactive triage simulator revealed important variability in both process and outcome of emergency triage.

BACKGROUND AND OBJECTIVES: (1) to evaluate the performance of emergency department triage; (2) to explore the variability of the triage process; and (3) to examine the reliability of a four-level triage scale, using an interactive triage simulator. METHODS: We developed 22 interactive computerized vignettes describing patients presenting at the Emergency Department. Each vignette displayed the presenting complaint and offered the possibility to ask questions and obtain vital signs before deciding on the triage severity rating. The vignettes were rated twice by 45 nurses and 8 physicians. RESULTS: (1) The concordance between the observed triage decision and an expert-attributed emergency level was perfect in 58% of the situations. Triage acuity was overestimated in 11%, and underestimated in 31%. (2) There was a wide variability in the triage process across observers and vignettes. The mean number of questions varied from 1.77 to 18.95 across individuals, and from 3.96 to 11.60 across vignettes. (3) Finally, the test-retest reliability of our instrument was good (weighted kappa = 0.82) but the interrater reliability was moderate (weighted kappa = 0.41). CONCLUSIONS: The computerized triage simulator is an innovative tool to evaluate the process and the performance of triage and to evaluate the reliability of a triage instrument.

Adult↗
PubMed1996

The need for pediatric-specific triage criteria: results from the Florida Trauma Triage Study.

OBJECTIVE: The objective of the Florida Trauma Triage Study was to assess the performance of state-adopted field triage criteria. The study addressed three specific age groups: pediatric (age < 15 years), adult (age 15-54 years), and geriatric (age 55+ years). Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult trauma patients to state-approved trauma centers. However, only five of the criteria are recommended for use with pediatric patients. This article presents the findings regarding the performance of the scorecard when applied to a pediatric population. DESIGN: We used state trauma registry data linked to state hospital discharge data in a retrospective analysis of trauma patients transported by prehospital providers to any acute care hospital within nine selected Florida counties between July 1, 1991, and December 31, 1991. We used cross-table and logistic regression analysis to determine the ability of triage criteria to correctly identify patients who were retrospectively defined as major trauma. We applied the field criteria to physiologic and anatomy/mechanism of injury data contained in the trauma registry to "score" the patient as major or minor trauma. To make our retrospective determination of major or minor trauma we used the protocols developed by an expert medical panel as described by E. J. MacKenzie et al. (1990). MAIN OUTCOME MEASURES: We calculated sensitivity, specificity, and the corresponding over- and undertriage rates by comparing patient classifications (major or minor trauma) produced by the triage criteria and the retrospective algorithm. We used logistic regression to identify which triage criteria were statistically significant in predicting major trauma. RESULTS: Pediatric cases accounted for 9.2% of the total study population, 6.0% of all hospitalized cases, and 6.8% of all trauma deaths. Of the 1505 pediatric cases available for analysis, the triage criteria classified 269 cases as expected major trauma and 1236 cases as expected minor trauma. The retrospective algorithm classified 78 cases as expected major trauma and 1427 cases as expected minor trauma. The resulting specificity is 84.8% (15.2% overtriage), and the sensitivity is 66.7% (33.3% undertriage). Logistic regression indicated that, of the eight state-adopted field triage criteria, only the Glasgow coma score, ejection from vehicle, and penetrating injuries have a statistically significant impact on predicting major trauma in pediatric patients. CONCLUSIONS: Although the state-adopted trauma scorecard, applied to a pediatric population, produced acceptable overtriage, it did not produce acceptable undertriage. However, our undertriage rate is comparable to the results of other published studies on pediatric trauma. As a result of the Florida Trauma Triage Study, a new pediatric triage instrument was developed. It is currently being field-tested.

Adolescent↗
PubMed2006

Automated vs manual triage for bioterrorist disaster: a blinded crossover feasibility study comparing personal digital assistant to paper-based triage.

INTRODUCTION: This article reports results of a National Institutes of Health/National Library of Medicine Small Business Innovation Research-funded research grant comparing paper-based and automated Palm handheld computer disaster triage documentation. OBJECTIVES: The aim of this study was to test the feasibility of automated handheld computer triage and compare it to handwritten triage. METHODS: A paired t test was used in an intraindividual, blinded, crossover study to compare the 2 methods of disaster triage by 2 objective measures--time and accuracy. A total of 57 experienced, licensed first responders participated. Results are from analysis of 8 disaster scenarios with a total of 400 patients triaged using the 2 methods of documentation, crossed over, blinded, and paired per participant. RESULTS: The study demonstrated the feasibility of using TriageDoc, a Palm personal digital assistant (PDA ) program, as a viable alternative to current manual disaster triage. Furthermore, the PDA program gave advantage to bioterrorist agent identification. CONCLUSIONS: The feasibility of an automated Palm (Palm, Inc., Sunnyvale, CA) PDA triage program was demonstrated in this study. Study limitations, by the number of participants and the fact it is feasibility research, are acknowledged. Nevertheless, the research demonstrated TriageDoc was as accurate or more accurate as the manual method of triage with a tendency to require less time. Also there was no statistically significant difference between research sites with respect to accuracy or time to completion when the TriageDoc system was used. The program provided consistency and had flexibility in adapting to the various differences in triage methods at different locations. Hence, PDA programs such as TriageDoc may have potential advantages over handwritten documentation for disaster triage.

Bioterrorism↗
PubMed2000

Triage nurses' decisions using the National Triage Scale for Australian emergency departments.

The initiation of emergency care primarily depends on the decisions made by the triage nurse. Triage decisions can therefore have a profound effect on the health outcomes of patients who present for emergency care. If the National Triage Scale (NTS) was effective in providing a standardized approach to triage, a patient with a specific problem should be allocated to the same triage category, irrespective of the institution to which they present or the personnel performing the role of triage. This study examines triage nurses' level of agreement in their allocation of triage categories to patients with specific presenting problems using the NTS. Relationships between demographic characteristics of participants and triage decisions are examined and implications of any variation for triage practice and patient outcomes are explored.

Career Mobility↗
PubMed2001

Emergency severity index triage category is associated with six-month survival. ESI Triage Study Group.

OBJECTIVE: The Emergency Severity Index (ESI) is a new five-level triage instrument. The objective of this study was to determine whether there is an association between ESI triage status and short-term survival. METHODS: This was a survival analysis for a population-based, stratified random sample of patients over the age of 14 years who visited an urban, university-affiliated hospital emergency department (ED). Measures included ESI triage category (1 through 5), vital status obtained from the Social Security Administration, date of death (if applicable), and survival time in days. Data were analyzed with Kaplan-Meier survival analysis. RESULTS: Eighty-seven percent (202/232) of a random sample of patients appeared in the Social Security vital status registry. During the 252-day follow-up period, 19 patients (9%) died, 161 (80%) lived, and 22 (11%) had an unknown vital status. The ESI triage level was strongly associated with vital status at six months (Kaplan-Meier chi-square 25.9, p<0.0001). No patient in triage categories 4 and 5 died (lower limits of the 95% confidence interval for survival, 92% and 93%, respectively); whereas survival in triage category 1 was 68%, and in categories 2 and 3 it was 86% and 83%, respectively. Most of the deaths occurred within 60 days after the index ED visit. Sensitivity analyses biased against the instrument continued to demonstrate the association between triage status and survival. CONCLUSIONS: The ESI triage status is associated with six-month survival. Patients with the highest three triage groups experienced decreased survival during the follow-up period, whereas all patients in the two lowest triage strata survived at least six months.

Adult↗
PubMed2003

The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department triage.

The Canadian Triage and Acuity Scale has received widespread acceptance in Canada as a reliable and valid tool for emergency department triage. The importance of accurate triage becomes more apparent as emergency department volumes increase, and resources shrink. The need to ensure that those patients requiring more urgent care receive care first is the basis for all triage scales. Through the Canadian Triage and Acuity Scale National Working Group, the scale became the recommended triage tool for Canadian emergency departments. Work has been done on the interrater reliability of Canadian Triage and Acuity Scale among health care providers. There is a need to further assess the validity of the scale. This scale has now been applied in the out of hospital setting by paramedics and is being used in measurements of emergency physician workload. The future may see an electronic triage tool develop for emergency department use to reduce variability in its application. The Canadian Triage and Acuity Scale has become an integral component of Canadian emergency departments.

Canada↗
PubMed2006

Emergency department triage: is there a link between nurses' personal characteristics and accuracy in triage decisions?

INTRODUCTION: A common task of registered nurses is to perform emergency department triage, often using an especially designed triage scale in their assessment. However, little information is available about the factors that promote the quality of these decisions. This study investigated personal characteristics of registered nurses and the accuracy in their acuity ratings of patient scenarios. METHODS: Using the Canadian Triage and Acuity Scale (CTAS), 423 registered nurses from 48 (62%) Swedish emergency departments individually triaged 18 patient scenarios. RESULTS: The registered nurses' percentage of accurate acuity ratings was 58%, with a range from 22% to 89% accurate acuity ratings per registered nurse. In total, 60.3% of the registered nurses accurately triaged the scenarios in 50-69% of the cases. No relationship was found between personal characteristics of the registered nurses and their ability to triage. DISCUSSION: The lack of a relationship between personal characteristics of registered nurses and their ability to triage suggests that there might be intrapersonal characteristics, particularly the decision-making strategies used which can partly explain this dispersion. Future research that focuses on decision-making is likely to contribute in identifying and describing essential nursing characteristics for successful emergency department triage.

Clinical Competence↗
PubMed2005

Triage nurse perceptions of the use, reliability and acceptability of the Toowoomba Adult Triage Trauma Tool (TATTT).

OBJECTIVE: The 'Toowoomba Adult Triage Trauma Tool' (TATTT) is a computerised clinical decision support tool developed to provide an evidence-based, valid and consistent method of triage assessment and categorisation. The objective of this study was to determine the most appropriate training and testing strategy for implementing the TATTT and to evaluate its acceptability for assisting in the triage prioritization process. METHODS: Triage nurses (15) from two hospitals underwent training in the TATTT and were tested on its application. Semi-structured interviews gathered their perceptions of the training, the methods for testing and the acceptability of the TATTT for assisting in triage. RESULTS: The TATTT was viewed positively by all but one of the nurses. Participants believed that it provided clear direction in the triage assessment process, increased their confidence in reaching a decision and would be comfortable in adopting the TATTT in clinical practice. CONCLUSIONS: The study has shown that the TATTT is acceptable to users and is viewed as a viable alternative to current triage practice.

Adult↗
PubMed1995

"Triaging out" children with minor illnesses from an emergency department by a triage nurse: where do they go?

OBJECTIVE: To determine whether parents of children with minor illnesses actually seek care after they receive advice and are referred from an emergency department by an ED triage nurse. DESIGN: Descriptive study of 100 parents with children who were given advice and referred from an urban, pediatric tertiary care center by an ED triage nurse. METHODS: A 10-item telephone survey was designed to determine whether parents took their children to the primary health care provider to whom they were likely to be referred. Parental perceptions of the severity of the child's medical problem, of the nurse's understanding of the problem, and of the satisfaction with the referral process were analyzed with Fisher's exact test. RESULTS: Most (79%) of the subjects did not seek care with a primary health care provider per referral. However, 81% of parents believed the triage nurse understood the child's problem (rated 4 or 5 on a 5-point Likert scale in which 5 meant "completely understood" the child's problem) and 79% were satisfied with being referred from the emergency department (rated 4 or 5 on a 5-point Likert scale in which 5 meant "most satisfied" with being "triaged out"). CONCLUSION: Parental perceptions of the ED triage nurse's understanding of the child's complaint has a significant positive relationship on the parent's satisfaction with the advice and referral directives given by the nurse for the health care needs of the child. No children in this study experienced a worsening in their condition. Hence the ED triage nurse can be a valuable resource in educating and fostering primary health care practices within the community.

Adolescent↗
PubMed1981

Computerized triage of pediatric patients: automated triage algorithms.

Pediatric triage algorithms which were prospectively and retrospectively validated in a pediatric acute care facility serve as the basis for the development of a simplified pediatric triage checklist. This checklist is used by minimally trained nonprofessionals to assign safely the care urgency categories of the chief complaints of pediatric "walk-in" patients. This article describes the background of the pediatric triage checklist and its adaptation to a computerized triage system. This system not only allows for safe triage, but also creates a mechanism for rapid, organized retrieval of data from individual and group patient triage encounters that is useful for the study and planning of health care delivery.

Child↗
PubMedDate not supplied

Evaluation of the Pediatric Trauma Triage Checklist as a prehospital pediatric trauma triage tool for the state of Florida.

INTRODUCTION: Triage of injured children poses a significant challenge for prehospital care providers because there is not single trauma triage tool in use that has been developed specifically for children. The pediatric trauma score (PTS) probably is the single most studied and tested trauma triage tool developed solely for the pediatric population, and is an effective predictor of both severity of injury and potential mortality in injured children. However, the pediatric trauma score has been found to be an ineffective prehospital triage tool because it is not "user friendly" for field personnel. As such, the PTS has been modified to generate the more user-friendly "pediatric trauma triage checklist (PTTC)." METHODS: This study retrospectively reviewed 106 prehospital run reports to determine whether the patient met one or more of the criteria in the PTTC. By applying the MacKenzie algorithm to outcome data for each case, it was possible to determine whether the patient should have been sent to a trauma center. RESULTS: The PTTC demonstrated a sensitivity of 86.2%, a specificity of 41.6%, and an accuracy of 66.0% The PTTC demonstrated an overtriage rate of 58.3% and an undertriage rate of 13.8% When compared with a previous study, the PTTC demonstrated a 74% increase in overtriage. However, the 59% reduction in undertriage is more important. CONCLUSIONS: Use of the PTTC appears to have merit as a pediatric prehospital trauma triage tool but further study is recommended. The PTTC should be tested in a prospective, multiregional study involving a sample size sufficient to reach statistical significance.

Algorithms↗
PubMed1996

The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study.

Since 1990, Florida has used a uniform set of eight triage criteria, known as the trauma scorecard, for triaging adult patients with trauma to state-approved trauma centers. If any one of the eight criteria are met, paramedics classify the patient as a "trauma alert" and transport to a state-approved trauma center. Widespread concern within the trauma care community that the scorecard was not providing an effective tool for adult trauma triage, particularly for older adults, was a motivating force for conducting an evaluation of the trauma scorecard's performance. Thus, the Florida Department of Health and Rehabilitative Services, Office of Emergency Medical Services initiated a research effort to assess the effectiveness of the state-adopted trauma triage criteria for adults, giving special attention to geriatric trauma. The results of the Florida Trauma Triage Study indicate that the eight triage criteria comprising the trauma scorecard produce unacceptable levels of undertriage in elderly patients (age 55 years or older) with life-threatening injuries.

Abbreviated Injury Scale↗