Triage Duration Research Articles

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial

BackgroundDeciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience. PurposeThis study was conducted to evaluate the effect of a “computer-based emergency department triage decision support system (DSS),“ which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data. MethodsSingle-group, pretest–posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied. ResultsThe effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest. ConclusionsThe DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

GAMBARAN RESPONSE TIME DAN LAMA TRIAGE DI INSTALASI GAWAT DARURAT (IGD) DI RSUD KARAWANG

Emergency is a conditional that requires immediate handling to eliminate the threat of the patient life. All action taken in the emergency room must be truly effective and afficient, because patients will lose their lives in just minute. Response time is the time of intervention in emergency area that started from the patient coming until gets initial assesment. Triage is the process of selecting and sorting patients based on their priority level of emergency. The purpose of this study was to determine the description of response time and triage duration at emergency department RSUD Karawang. Reseach methods with cross sectional approach. Selection of samples with total sampling by 21 respondents. Instrument research using observation sheets. The result showed that the average response time and triage duration for 30 days was 55,66 seconds (0,92 minutes) and 41,66 seconds (0,69 minutes). More rapid response time and triage duration will affect to the patient, the faster handling to the patient will be treated the risk of getting worse the patient’s condition will decrease. Response time and triage duration in emergency department RSUD Karawang was according to standarts.

Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system

AimsThis process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). Design & MethodsSemi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. ResultsThrough a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. ConclusionBased on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.

Interruption of initial patient assessment in the emergency department and its effect on patient perception of care quality.

Triage is a critical first step in appropriately caring for patients in the emergency department (ED). Patients' assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction and patient's perception of the care they received. Prospective, observational, cohort study conducted in the ED of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. Surveys were completed for 178 observations. In total, 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients' perceptions were not influenced by interruptions. While patient satisfaction is essential, a lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.

Emergency nurse triage in the hospital information management system: A quality improvement study

BackgroundAssessment of nurse triage decision accuracy and triage times is currently carried out through paper-based methods. This quality improvement study aims to develop a method that can assess the accuracy and duration of nurse triage decisions based on a computerized system and to share an example of the application of this method. MethodsThis is a descriptive quality improvement study. The study was carried out in two stages between March and May 2019. The functionality of the developed method was examined using 3835 patients' triage data, which were obtained between June 1 and 14, 2019. ResultsWith this study, the determination of the accuracy and duration of nurse triage decisions was accomplished with a computerized process based on real patient outputs, and the accuracy and duration of these decisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all triage nurses. ConclusionThe study result outputs can be integrated into quality processes and can be used internationally as performance assessment criteria and quality indicators for triage nursing.

Comparison of Four-Level Modification Triage with Five Level Emergency Severity Index (ESI) Triage Based on Level of Accuracy and Time Triase

The triage system currently recommended by the Association of Emergency Physicians (ACEP) and Emergency Nurses Association (ENA) is a five levels triage, Emergency Severity Index (ESI) due to more structured, concise, and clear. Cibabat Hospital used a relatively new triage of four modified levels of the Australian Triage Scale (ATS) which accuracy and time triage have not been evaluated. The purpose of this study was to compare the four level triage of modification of ATS and five levels of ESI triage based on accuracy and time triage. The researcher used a quantitative quasi-experimental design with samples of triage activities totaling 38 in the control group and 38 intervention groups, using accidental sampling techniques. Univariate analysis consisted of frequency distribution for nurse characteristics, time triage and accuracy, bivariate analysis used the Mann-Whitney test. The results showed there were no differences, triage modification of ATS with ESI triage in accuracy (p-0.488), and length of triage (p-0.488) ESI triage accuracy was in the expected triage category (76.3%), under triage (13.2%), and over triage (10.5%). Triage modified ATS, expected triage (73.7%), under triage (18.4%), and over triage (7.9%). ESI triage has more expected and less under triage than ATS modification triage. Under triage caused prolong waiting times, unexpected risks, increases morbidity and mortality. Based on the length of time, ESI triage averaged 167 seconds, triage modification of ATS an average of 183 seconds. ESI flowchrat is easier to understand because is simple, has slight indicators in each category. Conclusion of this study is there is no significant difference in the level of accuracy and duration of triage. However, based on data distribution, ESI triage gives more expected triage decisions, less under triage and 16 seconds faster. Suggestions given to the Cibabat Hospital, can use ESI triage as an alternative triage assessment option because easy to use, structured, simple, and clear.

Factors affecting the accuracy of nurse triage in tertiary care emergency departments.

OBJECTIVES:The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department.METHODS:This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00.RESULTS:The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% (n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts (P < 0.05).CONCLUSIONS:The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients.

Assessment of Quality of Pediatric Emergency Triage and Its Associated Factors in Wolaita Zone, Ethiopia

Background: Most deaths of children in hospital frequently occur within the first 24 hours of admission. Immediate triage on arrival may prevent many of these deaths. Pediatric emergency triage assessment and treatment was introduced in 2014 in Ethiopia, however, there is no evidence which shows its quality and associated factors in the country. Objective:-This study aimed to assess the quality of pediatric emergency triage and its associated factors in selected hospitals of Wolaita zone 2017. Methods: A facility-based cross-sectional study design was used March to April 2017. A total of 178 health care workers (HCWs) were included in this study. The data was collected by using a self-administered questionnaire on the HCWs, and an observation checklist for hospitals assessment. We performed descriptive and multivariable logistic regression analyses; adjusted odds ratio and 95% CI were used to determine statistically significant associations. Results: This study indicated that 41.7% of HCWs did not correctly define triage, 81% did not know triage duration, 85.7% did not identify all triage categories and 64% did not categorize child with urgent signs. Conclusion: The overall quality of pediatric emergency triage service was poor.

Effects of Interruptions on Triage Process in Emergency Department: A Prospective, Observational Study.

For 130 million people seeking emergency treatment in the United States, incomplete or inaccurate triage examination can result in delays, which could compromise patient outcomes. The purpose of this study was to identify triage interruptions and determine how interruptions affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes will allow nurses and other health care providers to develop interventions to mitigate the impact.

A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa.

This was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined. A total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001). Accuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles. AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575-580.

LO22: Improving the pain experience for children with limb injury: a city-wide quality improvement collaborative

Introduction: Undertreated pain is known to cause short and long-term harm in children. Limb injuries are a common painful condition in emergency department (ED) patients, accounting for 12% of ED visits by children. Our city has one pediatric ED in a freestanding children’s hospital and 3 general ED’s that treat both adults and children. 68% of pediatric limb injuries in our city are treated in the pediatric ED and 32% are treated in a general ED. A quality improvement (QI) initiative was developed at the children’s hospital ED in April 2015 focusing on “Commitment to Comfort.” After achieving aims at the childrens hospital, a QI collaborative was formed among the pediatric ED and the 3 general ED’s to 1) improve the proportion of children citywide receiving analgesia for limb injuries from 27% to 40% and 2) reduce the median time to analgesia from 37 minutes to 15 minutes, during the time period of April-September, 2016. Methods: Data were obtained from computerized order entry records for children 0-17.99 years visiting any participating ED with a chief complaint of limb injury. Project teams from each site met monthly to discuss aims, develop key driver diagrams, plan tests of change, and share learnings. Implementation strategies were based on the Model for Improvement with PDSA cycles. Patient and family consultation was obtained. Process measures included the proportion of children treated with analgesic medication and time to analgesia; balancing measures were duration of triage and length of stay for limb injury and all patients. Site-specific run charts were used to detect special cause variation. Data from all sites were combined at study end to measure city-wide impact using 2 and interrupted time series analysis. Results: During the 3.5-year time period studied (April 1, 2014-September 30, 2017), there were 45,567 visits to the participating ED’s by children 0-17.99 years with limb injury. All visits were included in analysis. Special cause was detected in run charts of all process measures. Interrupted time series analysis comparing the year prior to implementation at the childrens hospital in April 2015 to the year following completion of implementation at the 3 general hospitals in October 2016 demonstrated that the proportion of patients with limb injury receiving analgesia increased from 27% to 40% (p&lt;0.01), and the median time from arrival to analgesia decreased from 37 to 11 minutes (p&lt;0.01). Balancing measure analysis is in progress. Conclusion: This multisite initiative emphasizing “Commitment to Comfort” was successful in improving pain outcomes for all children with limb injuries seen in city-wide ED’s, and was sustained for one year following implementation. A QI collaborative can be an effective method for spreading improvement. The project team is now spreading the Commitment to Comfort initiative to over 30 rural and regional EDs throughout the province through establishment of a provincial QI collaborative.

Decreasing triage time: effects of implementing a step-wise ESI algorithm in an EHR.

To determine if adapting a widely-used triage scale into a computerized algorithm in an electronic health record (EHR) shortens emergency department (ED) triage time. Before-and-after quasi-experimental study. Urban, tertiary care hospital ED. Consecutive adult patient visits between July 2011 and June 2013. A step-wise algorithm, based on the Emergency Severity Index (ESI-5) was programmed into the triage module of a commercial EHR. Duration of triage (triage interval) for all patients and change in percentage of high acuity patients (ESI 1 and 2) completing triage within 15 min, 12 months before-and-after implementation of the algorithm. Multivariable analysis adjusted for confounders; interrupted time series demonstrated effects over time. Secondary outcomes examined quality metrics and patient flow. About 32 546 patient visits before and 33 032 after the intervention were included. Post-intervention patients were slightly older, census was higher and admission rate slightly increased. Median triage interval was 5.92 min (interquartile ranges, IQR 4.2-8.73) before and 2.8 min (IQR 1.88-4.23) after the intervention (P < 0.001). Adjusted mean triage interval decreased 3.4 min (95% CI: -3.6, -3.2). The proportion of high acuity patients completing triage within 15 min increased from 63.9% (95% CI 62.5, 65.2%) to 75.0% (95% CI 73.8, 76.1). Monthly time series demonstrated immediate and sustained improvement following the intervention. Return visits within 72 h and door-to-balloon time were unchanged. Total length of stay was similar. The computerized triage scale improved speed of triage, allowing more high acuity patients to be seen within recommended timeframes, without notable impact on quality.

Correlation of Performance Indicators and Productivity: A Cross Sectional Study of Emergency Departments in Tehran, Iran During Year 2016

Background: Effective manpower is the main factor in success and significant achievement of health organizations. Objectives: This study was conducted to assess nursing perceptions regarding performance indicators and its correlation with productivity within the emergency departments of hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, during year 2016. Methods: This study was conducted by the cross sectional method, during year 2016. In this cross sectional study, the emergency departments of 4 hospitals of Shahid Beheshti University of Medical Sciences in Tehran were assessed. All nurses of emergency departments were selected through Census sampling methods. One of the researchers made a set of questionnaires for the assessment of the performance of nurses and a checklist as a means of productivity indicators to collect the data. Statistical analysis was conducted by the SPSS software version 18 and Pearson correlation test, T test, and analysis of variance (ANOVA). Results: The performance of the nurses had a positive aptitude with the percentage of the patients, whose condition was determined within 6 hours and the percentage of the remaining patients, whose condition was resolved within 12 hours in the studied hospitals. On the contrary, the performance of the nurses had a negative correlation with average triage duration in the studied hospitals. Moreover, according to Pearson’s correlation coefficient, it could be said that the performance of the nurses had a negative correlation with unsuccessful CPR percentage indicator and also with the percentage of discharge against medical advice in the studied hospitals. Conclusions: According to the results, in order to achieve maximum outputs as productivity, the dimensions of performances needed to be improved. The Kardex evaluation items and shift reception evaluation achieved the lowest scores and need greater attention.

Inter-rater reliability between nurses for a new paediatric triage system based primarily on vital parameters: the Paediatric Triage Instrument (PETI)

IntroductionThe major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage...

Triage duration times: a prospective descriptive study in a level 1° emergency department

Triage is the most important tool for clinical risk management in emergency departments (ED). The timing measurement of its phases is fundamental to establish indicators and standards for the optimization of the system. To evaluate the duration time of the phases of triage; to evaluate some variables exerting influence on nurses' performance. prospective descriptive study performed in the ED of Careggi Teaching Hospital in Florence. 14 nurses enrolled by stratified randomization proportion (1/3 of the whole staff ), according to classes of length of service. Triage processes on 150 adult patients were recorded. The mean age of nurses was 39.7 years (SD ± 5.2, range 29-50); the average length of service was 10.3 years (SD ± 4.4, range 3-18); average of triage experience was 8.6 years (SD ± 4.3, range 2-13). The median time from patient's arrival to the end of the triage process was 04': 04" (range 00':47"- 18':08"); the median duration of triage was 01':11" (range 00':07" -11':27"). The length of service and triage experience did not influence the medians of recorded intervals of time, but there were some limitations due to the low sample size. Interruptions were observed 111 (74%) of triage cases. the recorded triage time intervals were similar to those reported in international literature. Actions are needed to reduce the impact of interruptions on triage process' times.

Status of accessible quality indices in the hospitals of Shahid Beheshti University of Medical Sciences according to accreditation in 2015

Introduction: The accreditation process is conducted to enhance the organizational quality and outcomes based on the localized standards. The objective of the study was to compare quality indices in hospitals of Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran with different accreditation degrees. Materials and Methods: Ten indices, representing the quality measures of inpatient cares, were selected among accredited hospitals based on importance and patient influences. In this applied descriptive study, data of 11 teaching hospitals of SBUMS were studied and analyzed by SPSS 21 using descriptive statistics and ANOVA in 2015. Data were collected from hospital records. Results: The most favorable indices - patients' satisfaction with emergency and hospitalization services, mean duration of triage (levels 2, 3, 4, and 5), and unsuccessful cardiopulmonary resuscitation (CPR) - were in the lowest ranking hospitals. Six of 10 indices, including cesarean, the death level, the discharge rate of admitted patients in the emergency department and hospital wards by personal consent, the patients' satisfaction with the hospitalization and emergency services, mean duration of triage (levels 2, 3, 4, and 5), and unsuccessful CPR were the most unfavorable in hospitals with the highest ranking, i.e., the first excellent degree. Conclusion: There was no significant difference in the indices of hospital care processes with different accreditation degrees. There were also reverse correlations between the direction of outcome changes and the accreditation level in some domains, which might require reassessment of the conduction of the program.

Emergency department triage performance timing. A regional multicenter descriptive study in Italy

ObjectivesWe explored the time employed by nurses to perform the ED triage process in the clinical setting. Moreover, we assessed the influences on triage timing performance exerted by variables related to nurses, local EDs' features, and by interruptions. MethodsThis is a multicenter prospective descriptive-explorative study performed in 11 EDs of the Tuscany region (Italy), using a 5 tier triage system. The sample was made up of 1/3 of nurses working in each ED. Sampling was performed by a stratified proportional randomization (length of service classes: <5 years; 5–10 years; >10 years). Triage nurses were observed during their triage work-shift. ResultsIn 2014, 120 nurses were observed, during 1114 triage processes. The timings of triage phases were: waiting time to triage, median 2.55 min (IQR 1.28–5.03 min; range 0.1–56.25 min); triage duration, median 2.58 min (IQR 1.36–4.35 min; range 0.07–50 min). 400 interruptions were recorded (35.9%). In 9.9% there were 2 interruptions at least. There were significant differences in the medians of triage duration among the years of nurses' triage experience (P < 0.001). The presence of interruption was significantly associated with the increasing of the time intervals in all the triage phases (P < 0.0001). Finally, we recorded significant differences in all the triage time phases between the EDs. ConclusionWe found that the nurses triage time performances are similar to other triage systems in the world.

Pilot Testing of Triage Coding System in Home-based Palliative Care Using Edmonton Symptom Assessment Scale.

Introduction:Home-based palliative care is an essential model of palliative care that aims to provide continuity of care at patient's own home in an effective and timely manner. This study was a pilot test of triage coding system in home-based palliative care using Edmonton Symptom Assessment System (ESAS) scale.Methods:Objective of the study was to evaluate if the triage coding system in home-based palliative care: (a) Facilitated timely intervention, (b) improved symptom control, and (c) avoided hospital deaths. Homecare services were coded as high (Group 1 - ESAS scores ≥7), medium (Group 2 - ESAS scores 4–6), and low (Group 3 - ESAS scores 0–3) priority based on ESAS scores. In high priority group, patients received home visit in 0–3 working days; medium priority group, patients received home visit in 0–10 working days; and low priority group, patients received home visit in 0–15 working days. The triage duration of home visit was arbitrarily decided based on the previous retrospective audit and consensus of the experts involved in prioritization and triaging in home care.Results:“High priority” patients were visited in 2.63 ± 0.75 days; “medium priority” patients were visited in 7.00 ± 1.5 days, and “low priority” patients were visited in 10.54 ± 2.7 days. High and medium priority groups had a statistically significant improvement in most of the ESAS symptoms following palliative home care intervention. Intergroup comparison showed that improvement in symptoms was the highest in high priority group compared to medium and low priority group. There was an 8.5% increase in home and hospice deaths following the introduction of triage coding system. There was a significant decrease in deaths in the hospital in Group 1 (6.3%) (χ2 = 27.3, P < 0.001) compared to Group 2 (28.6%) and Group 3 (15.4%). Group 2 had more hospital deaths. Interval duration from triaging to first intervention was a significant predictor of survival with odds ratio 0.75 indicating that time taken for intervention from triaging was more significantly affecting survival than group triaging.Conclusion:Pilot study of testing triaging coding system in home-based palliative care showed, triage coding system: (a) Facilitated early palliative home care intervention, (b) improved symptom control, (c) decreased hospital deaths, predominantly in high priority group, and (d) time taken for intervention from triaging was a significant predictor of survival.

Impacts of the introduction of a triage system in Japan: A time series study

The aim of the present study was to measure and compare the effectiveness of nursing triage before and after introduction of the Japanese Triage and Acuity Scale (JTAS), the Japanese version of the Canadian Triage and Acuity Scale (CTAS), during emergency treatment. Surveys of triage nurses and emergency physicians were conducted before and after JTAS introduction. Respondents were triage nurses (before 112 cases, after 94 cases), emergency physicians (before 50, after 41), and triaged patients (before 1057, after 1025) from seven separate emergency medical facilities. The results showed that nursing triage using the JTAS shortened “time from registration to triage” by 3.8min, “triage duration” by 1min, “time from registration to physician” by 11.2min, and “waiting time perceived by patients to see a physician” by 18.6min (p<0.001). The difference in assigned level of urgency between triage nurses and emergency physicians decreased from 34.2% to 12.2% (p<0.001), over-triage decreased from 24.7% to 8.6% (p<0.001), and under-triage decreased from 9.5% to 3.6% (p<0.001). Furthermore, assessment agreement between triage nurses and emergency physicians increased significantly, from weighted κ=0.486 to weighted κ=0.820. These findings suggest that the introduction of the JTAS promoted more effective nursing triage and medical care.

Disaster Plan of Hospital and Emergency Service in the Van Earthquake

Objective: One of the most important occupation field of emergency medicine specialists is disaster medicine. Health services within disaster medicine are quite different from individual health services. Although triage practice is a great problem for hospitals in such kind of incidents; it enables all the medical interventions. In this study, we have aimed to present hospital emergency plan and our triage practice in emergency unit in Van earthquake. Material and Methods: Color coding system was used in triage practice ay Van Region Education and Research Hospital in Van earthquake. All the units, duties of personnel and the places of duty were determined. Emergency unit and recucitation room was marked with red area, intervention tents were marked with yellow area, hospital garden was marked with green area, morgue was marked with black area. There was a trauma team and an emergency medicine spacialist at the entrance of hospital and every corner determined. Patients were evaluated again and again periodically. Results: One thousand ninety patients registered in three earthquakes in total. There were 68 casualties. Total triage duration was 1350 minutes and average triage duration is 1.23 min. Conclusion: Every hospital should have their own disaster plan and emergency medicine specialists must be available in the preparation and conduction of disaster plans. Demonstrations should be carried out within disaster plan; demonstrations should be expanded in a way that it would include all the hospitals and other institutions in the city. (JAEM 2012; 11: 86-92)