Implementation Of Triage System Research Articles

Personalised exercise rehabilitation in cancer survivorship: the percs triage and referral system study protocol

BackgroundTo effectively embed exercise rehabilitation in cancer survivorship care, a co-ordinated system of acute and community exercise rehabilitation services, forming a stepped model of care, is recommended. Patients can be directed to the exercise rehabilitation service which best meets their needs through a system of assessment, triage and referral. Triage and referral systems are not yet widely applied in cancer survivorship practice and need to be evaluated in real-world contexts. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) study aims to evaluate the real-world application of an exercise rehabilitation triage and referral system in cancer survivors treated during the COVID-19 pandemic. Secondary aims are to evaluate change in physical and psychosocial outcomes, and to qualitatively evaluate the impact of the system and patient experiences, at three months after application of the triage and referral system.MethodsThis study will assess the implementation of an exercise rehabilitation triage and referral system within the context of a physiotherapy-led cancer rehabilitation clinic for cancer survivors who received cancer treatment during the COVID-19 pandemic. The PERCS triage and referral system supports decision making in exercise rehabilitation referral by recommending one of three pathways: independent exercise; fitness professional referral; or health professional referral. Up to 100 adult cancer survivors treated during the COVID-19 pandemic who have completed treatment and have no signs of active disease will be recruited. We will assess participants’ physical and psychosocial wellbeing and evaluate whether medical clearance for exercise is needed. Participants will then be triaged to a referral pathway and an exercise recommendation will be collaboratively decided. Reassessment will be after 12 weeks. Primary outcomes are implementation-related, guided by the RE-AIM framework. Secondary outcomes include physical function, psychosocial wellbeing and exercise levels. Qualitative analysis of semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) will provide insights on implementation and system impact.DiscussionThe PERCS study will investigate the real-world application of a cancer rehabilitation triage and referral system. This will provide proof of concept evidence for this triage approach and important insights on the implementation of a triage system in a specialist cancer centre.Trial registrationThis study is registered on ClinicalTrials.gov, registration number: NCT05615285, date registered: 21st October 2022.

Implementation of Triage System and Shortening Patient Journey Time to Prevent COVID-19 Transmission in a University Hospital during a Pandemic.

To explore the characteristics of the patient under investigation (PUI), and the routes and the patient journey time in our outpatient service, we examined the demographic data, presenting symptoms, risks of contact with COVID-19 cases, and the results of real-time polymerase chain reaction (PCR) tests in PUI cases from March to May 2020. The contact time, transfer time and total journey time of patient journey routes in our hospital were also explored. The results were shown in numbers, percentages and medians (interquartile range, IQR). A total of 334 PUI cases were identified from our triage system. The median (IQR) age was 35 (27, 47) years. Cough was the most common presenting symptom (56.2%), while fever (≥37.5 °C) was found in only 19.8% of the cases. The median (IQR) time of onset of the presenting symptoms was 3 (1, 5) days. The most common risk of contact with COVID-19 cases found during the triage was living in or returning from an outbreak area. Fifteen (4.5%) of the PUI cases had positive real-time PCR tests. The contact time and transfer time were longest in the PUI ward and from the Emergency Department (ED) to the PUI ward, respectively. Plans and actions to shorten the transfer time between the ED and the PUI ward and the total journey time should be developed.

A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries.

BackgroundStroke is a leading cause of death and disability globally, with an increasing incidence in low- and middle-income countries (LMICs). The successful treatment of acute stroke requires an organized, efficient and well-resourced emergency care system. However, debate exists surrounding the prioritization of stroke treatment programs given the high costs of treatment and the increased incidence of hemorrhagic stroke in LMICs. Economic data is helpful to guide evidence-based priority setting in health systems development, particularly in low-resource settings where scarcity requires careful stewardship of resources. This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings.MethodsThe authors conducted a PRISMA style systematic review of economic evaluations of interventions to address acute stroke in LMICs. Five databases were systematically searched for articles, which were then reviewed for inclusion.ResultsOf the 153 unique articles identified, 11 met the inclusion criteria. Four studies demonstrate the heavy economic burden on patients and households due to stroke. Two studies estimate that preventive measures are more cost-effective than acute treatments. Four studies directly examine the cost-effectiveness of thrombolysis and thrombectomy in three middle-income countries (Iran, China, and Brazil) with results ranging from roughly $2578 to $34,052 (2019 USD) per quality adjusted life-year saved. These results are similar to the cost-effectiveness ratios estimated in high-income settings. Finally, one study examined a care bundle that included acute treatment elements.ConclusionsThe findings reinforce the need for additional research support informed decision-making. The available evidence suggests that preventive measures should be prioritized over emergency treatment for acute stroke, particularly in settings of resource scarcity. Cost-effectiveness ratios do not compare favorably to estimates for other emergency care interventions in LMICs, such as basic emergency care training, implementation of triage systems, and basic trauma care. Cost-effectiveness is also likely to vary depending on local epidemiology. Overall, decision-makers should balance the economic evidence alongside social, political and cultural priorities when making resource allocation choices.

On triage system

Introduction: Triage is the process of categorizing patients in emergency situation according to the severity of their injuries or sickness. This is done in order to give medical attention to those who need it first, to minimize loss of life from injuries. Aims: This article aims to create an electronic triage system based on the Raspberry Pi computer and Arduino microcontroller. The Raspberry Pi computer wirelessly receives data measured by the Arduino and analyses the data after which it automatically categorizes patients with minimal human intervention. Results: The Raspberry Pi runs a graphical user interface-based system that is used to display results and allow for users to input data into the database. The system contains two functionalities, emergency mode (MODE 1) and emergency department mode (MODE 2). MODE 1 is used for urgent outdoor emergency scenarios such as motor vehicle accident with multiple casualties, to determine the seriously injured victims. MODE 2 can be integrated in a medical center where it is used to determine which patient needs immediate attention in a scenario where there are so many patients waiting. In MODE 2, patient's recent vitals readings can be graphically viewed for further analysis and medical doctors can comment on each patient's progress for future reference. This data is then uploaded to an online server. Conclusion: The article focuses on the design and implementation of triage system which is based on Raspberry Pi.

Validating the implementation of the triage system in an emergency department in a University Hospital

Introduction: The implementation of triage systems seeks to aid patient organisation in order to assure smooth patient flow. Inconsistency in the application of the triage system at a local university hospital has been a recent concern for the administrative faculty. Therefore, our aim was to validate the implementation of the Canadian Triage and Acuity Scale (CTAS), currently applied by nurses, in a university hospital. Materials and Methods: Patient information was collected in the Emergency Department and translated from real case scenarios into paper-based scenarios. A total of 49 cases were distributed among 45 nurses to categorise. The nurses' categorisations were compared with a CTAS expert's categorisations. Results: Of the 2,205 cases (49 cases each given to the 45 nurses), 49% (1,059 cases) were correctly categorised and 51% (1,146 cases) were miscategorised. Overtriage and undertriage percentages were 55.93% and 44.07%, respectively. The highest level of agreement between nurses and the expert categorisation was in category 1; the lowest was in category 5. Conclusion: The nurses' overall results were below expectations. Statistically significant variables affecting correct categorisation included age, experience, education level and nationality of the nurses. Nurses above the age of 45 years with more years of experience, obtained top scores. Nurses with the highest level of education also scored significantly higher. Filipino nurses scored better than nurses of other nationalities. With the widespread utilisation of triage systems in the region, further studies that evaluate their implementation are needed.

Providing emergency care and assessing a patient triage system in a referral hospital in Somaliland: a cross-sectional study.

BackgroundIn resource-poor settings, where health systems are frequently stretched to their capacity, access to emergency care is often limited. Triage systems have been proposed as a tool to ensure efficiency and optimal use of emergency resources in such contexts. However, evidence on the practice of emergency care and the implementation of triage systems in such settings, is scarce. This study aimed to assess emergency care provision in the Burao district hospital in Somaliland, including the application of the South African Triage Scale (SATS) tool.MethodsA cross-sectional descriptive study was undertaken. Routine programme data of all patients presenting at the Emergency Department (ED) of Burao Hospital during its first year of service (January to December 2012) were analysed. The American College of Surgeons Committee on Trauma (ACSCOT) indicators were used as SATS targets for high priority emergency cases (“high acuity” proportion), overtriage and undertriage (with thresholds of >25%, <50% and <10%, respectively).ResultsIn 2012, among 7212 patients presented to the ED, 41% were female, and 18% were aged less than five. Only 21% of these patients sought care at the ED within 24 hours of developing symptoms. The high acuity proportion was 22.3%, while the overtriage (40%) and undertriage (9%) rates were below the pre-set thresholds. The overall mortality rate was 1.3% and the abandon rate 2.0%. The outcomes of patients corresponds well with the color code assigned using SATS.ConclusionThis is the first study assessing the implementation of SATS in a post-conflict and resource-limited African setting showing that most indicators met the expected standards. In particular, specific attention is needed to improve the relatively low rate of true emergency cases, delays in patient presentation and in timely provision of care within the ED. This study also highlights the need for development of emergency care thresholds that are more adapted to resource-poor contexts. These issues are discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0531-3) contains supplementary material, which is available to authorized users.

Triage-Systeme in der Zentralen Notfallaufnahme

Central emergency units were established for medical and economic reasons in many German hospitals. The huge number of patients requiring treatment more or less urgent led to an implementation of triage-systems, which are known from abroad. Five of those triage-systems with different approaches are going to be presented below. The Manchester triage-system is the one of those, which can be transferred to German circumstances the best and is the most common clinical triage-system in Germany. Before implementing the above-mentioned systems to German emergency unit all of them need further development. Furthermore a scientific verification of the efficiency and the safety of triage-systems is necessary.