Triage Group Research Articles

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.

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...

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

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. 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. 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. 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.

Transcribing in triage: the Wrexham experience

The Manchester triage methodology and the practice of analgesic transcribing were introduced to the Accident & Emergency Department of the Wrexham Maelor Hospital in April 1998. The concept of nurse led transcribing is relatively new and its introduction was not without an element of administrative caution. The project was successfully implemented owing to the strategic input from a multidisciplinary group and elaborate steps towards quality assurance through audit. This paper describes the steps of implementation of this transcribing project and its successful completion through a prospective audit. Although there is a paucity of published literature in this topic, the Wrexham Pain Triage Group wishes to extend this implementation methodology into other areas of innovative nursing practice.

Do management algorithms improve chest pain triage?

To audit the use of management algorithms for chest pain in an emergency department. Prospective study of all patients with chest pain presenting to the emergency department of an urban teaching hospital between 12 January and 4 May 1997. Staff were asked to complete a standardised admission form that incorporated the risk stratification algorithms for managing patients with suspected acute coronary syndrome. Compliance with the use of management algorithms; concordance with a cardiologist's review of the triage grouping and admission/discharge decision; and major cardiovascular events over four months. Emergency department staff documented the triage group in 223 of 503 cases (45%). Concordance with the group assigned by a cardiologist was 70% (kappa = 0.73; SE kappa = 0.04). When the management algorithm was applied correctly, 92% of triage decisions were correct (95% confidence interval [CI], 87%-96%). The triage decision was less often correct when risk stratification was not done (78% [73%-83%], P < 0.001), overestimated (77% [66%-88%], P < 0.01), or underestimated (50% [18%-82%], P < 0.001). The proportion of patients free of major cardiovascular events at four-month follow-up was 50% for those with myocardial infarction with ST-segment elevation, 47% for those with a high short-term risk of an adverse cardiac event, 82% for those with intermediate risk, and 99% for those with a low risk or non-coronary chest pain (P < 0.001). Use of management algorithms by emergency staff was poor. When used, triage decisions were more likely to be correct. Subsequent outcome confirms that the NHMRC risk stratification algorithms are useful for prognostic stratification of patients with suspected acute coronary syndrome.

Impact of patient acuity on preference for information and autonomy in decision making.

To test the hypotheses that ED patients' desires for medical information and for autonomy in decision making are inversely related to increasing acuity of illness, increasing age, and lower level of formal education. The authors conducted a prospective study of ED patients who presented for care during seven nonconsecutive 24-hour periods. Of 804 patients approached, 665 completed a questionnaire that was administered by a trained research assistant. Patients rated their desire for medical information, and for participation in medical decision making, on two 10-cm visual analog scales. Patient acuity level was determined in routine fashion by trained triage nurses, who were unaware of the nature of this study. Desire for information was uniformly high, and did not vary statistically between triage groups (p = 0.41). The most acutely ill patients (level I) were more likely to be excluded by the research interviewer (p < 0.001). Of included level I patients, desire to participate was not decreased (p < 0.01). Higher level of formal education (p = 0.036) and younger age (p < 0.001) were associated with greater desire for autonomy in decision making. Among ED patients able to participate, higher acuity of illness was not associated with a decreased desire for medical information. Many very acutely ill patients preferred autonomy in medical decision making. Older patients and those with less formal education expressed a lesser desire for decision-making autonomy.

Which triage category patients die in hospital after being admitted through emergency departments? A study in one teaching hospital

Abstract Objectives: To quantify the number of deaths per triage category (scale 1–5, Australian National Triage Scale) occurring after admission to hospital via an emergency department and to examine the causes of death in each category. Setting: St Vincent's Hospital, Melbourne (Victoria, Australia) is an acute adult tertiary referral hospital. Methods: Electronic collection of all hospital admissions and their subsequent destination for the calendar year 1997, with chart and/or postmortem review to determine the cause of death. Results: The percentage of deaths per triage group decreased with urgency. Numerically, the largest group of all admissions and admissions followed by deaths consist of patients presenting in category 4 (semi‐urgent). Conclusions: Triage categories may be a useful tool for prioritizing acute patients, but patients in low triage categories often have fatal illnesses. Performance measurements and workload assessments for emergency departments may need to involve category 4 patients to take account of this factor.

The Development and Evaluation of an Obstetrical Triage Programme

Objective: to describe an obstetrical triage process and to evaluate its effectiveness and its effects on operative interventions in low risk pregnant women.Design: the study was a retrospective cohort comparing 1,706 women who delivered before triage, to 1,714 women who delivered following the triage process. The rates of Caesarean section, oxytocin use, epidural anaesthesia, operative vaginal delivery, episiotomy, and admission to the Neonatal Intensive Care Unit (NICU) were evaluated.Results: the before triage and triage groups were comparable for age, parity, gestational age, and patient care status in the time of labour and delivery. Patients in the triage group were more likely to have had previous lower segment Caesarean sections (LSC), a vertex presentation, and a baby <4,000gm. Seventy-six point three percent of the wornen in the triage group were admitted directly to the labour and delivery area following assessment.There were fewer Caesarean sections in the triage group (9.0% compared to 11.2%), fewer women having epidural anaesthesia (60.7% to 64.0%), fewer women having episiotomy (41.2% to 44.8%), and fewer babies being admitted to the Neonatal Intensive Care Unit for >24 hours (2.6% to 4.0%). There was no effect of triage on induction or augmentation of labour with intravenous oxytocin.Conclusions: obstetrical triage is a safe process that may allow for more effective use of facilities and may be associated with fewer obstetrical interventions. A randomized, controlled trial needs to be undertaken to confirm these findings.

Triage

Triage is a model designed to overcome organizational and financial problems inhibiting the provision of appropriate care to the elderly. The model is being evaluated by the functioning status of the elderly, use of services, and health care costs of a group of elderly people served by Triage and one served by the conventional system. Preliminary results show, for the Triage group, improved mental functioning, less use of institutional services, and lower spending on conventional Medicare services.