Triage Knowledge Research Articles

Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers.

Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage. A total of 445 participants completed the course at 22 sites representing 88 different prehospital provider agencies. Pre- and posttests were administered to 62% of participants with an average score improvement of 53.4% (pretest range 30% to 56.6%; posttest range 85% to 100%). Improvements were seen in all categories including major and minor trauma in pregnancy, major trauma in adolescence, and knowledge of age limits and triage protocols. Education on triage guidelines and principles of pediatric resuscitation is essential for appropriate prehospital trauma management. Pre- and posttests may be used to demonstrate short term efficacy, while ongoing evaluations of practice patterns and follow-up surveys are needed to demonstrate longevity of acquired knowledge and identify areas of persistent confusion. Level IV, Case Series without Standardized.

Evaluation of the Knowledge of Triage among Nurses Working in Emergency Departments

Evaluation of the Knowledge of Triage among Nurses Working in Emergency Departments

Abstract WP373: Emergency Medical Service Stroke Education in a Rural Community: Need for Improvement

According to The Journal of Emergency Medical Services (EMS) the goal of stroke care is to minimize brain injury and maximize recovery. The stroke chain of survival links actions taken by patients, family, EMS and healthcare providers. Recent innovations in stroke treatment require accurate identification and appropriate triage to the appropriate treatment facility. Evidence in the literature demonstrates variability with EMS correct identification of stroke patients between 30% and 80%. Our 164 bed primary stroke center in rural Pennsylvania has been active in providing stroke education on an annual basis to emergency medical services within a two county radius. As part of our ongoing process improvement we wanted to evaluate the emergency medical technicians and paramedics knowledge of stroke signs and symptoms, their understanding of the evaluation, treatment and triage of stroke patients. A standard questionnaire with 14 variables was developed using the American Heart and Stroke Association prehospital guidelines. The questionnaire included 16 stroke and non stroke symptoms, identifying transport to primary verses comprehensive stroke centers and initial evaluation. A sample population of 90 emergency medical service staff were asked to complete the questionnaire with 28 (31%) responses received. All participants indicated they were confident to recognize stroke signs and symptoms but 6 of the non stroke items were chosen as stroke symptoms. All participants indicated they were confident in the initial evaluation of a stroke patient but 14 (50%) appropriately identified airway, breathing, circulation as the first evaluation. Evaluating triage knowledge, 26 (93%) stated confidence in decision to transport to a primary stroke center and 22 (79%) to a comprehensive stroke center, however, appropriate decision to transport to a primary stroke center was identified correctly by 46% a comprehensive stroke center 66%. In conclusion, results from this study suggest that in this rural setting, barriers exist in prehospital recognition and evaluation of the stroke patient for which proper education may be remediable. Our goal is to use this information to revise our current EMS stroke education program and enhance prehospital assessment and triage.

EFFECT OF IMPLEMENTING TRIAGE TRAINING COMPETENCIES ON NEWLY GRADUATED NURSES WORKING IN EMERGENCY HOSPITAL

Triage is one of the most important managerial and decision making concepts in emergency, it brings the most benefit to the greatest number of patients. Triage is important for redistributing and reducing waiting times and enhancing patient and family satisfaction and improving the quality of health care. Therefore, the aim of this study to determine the effect of implementing triage training competencies on newly graduated nurses (NGNs') working in emergency department (ED) at emergency hospital. Patients and Methods: A quasi experimental research design was utilized during the current study and it was conducted on 50 NGNs' who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in the Emergency Hospital at Mansoura University and who are willing to participate in the study was constitute the study sample (study group). While control group of (25 nurses) who have a bachelor degree of nursing and are involved in providing direct care for emergency patients in Talkha Hospital. Results: The mean triage knowledge score increased immediately and post program implementation for the study group from (32.9±1.73 to 32.6±1.78 out of a total score of 35) compared with (13.44±1.78) to (13.52±2.04) for the control group. Also, triage performance increased immediately and post program implementation for the study group from (135.5±4.26 to 134.42±2.41 out of a total score of 140) compared with (56.44±8.21) to (56.76±7.79) for the control group. Moreover, there was a highly statistical significance difference between the study group and control group in relation to NGNs' knowledge and practice in post and two month post program implementation *p = 0.001. While there was no statistical significant difference between study group and control group in pre program implementation. Conclusion: The findings of this study indicated that there are deficits in triage knowledge and skills of NGNs' working in the ED of the emergency hospital. With these findings it is therefore imperative to establish proper triage training program that will help to establish and improve NGNs’ knowledge and skills on triaging in emergency hospital.

Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey

BackgroundIn a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician’s to correctly triage patients in a simulated mass casualty incident.MethodsThe study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course.ResultsThe triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises.ConclusionThe mnemonic ABCDE doesn’t significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians’ knowledge of triage, within the ATLS context or separately, are warranted.

A Comparative Study of the Effect of Triage Training by Role-Playing and Educational Video on the Knowledge and Performance of Emergency Medical Service Staffs in Iran

Educating emergency medical staffs in triage skills is an important aspect of disaster preparedness. The aim of the study was to compare the effect of role-playing and educational video presentation on the learning and performance of the emergency medical service staffs in Khozestan, Iran A total of 144 emergency technicians were randomly classified into two groups. A researcher trained the first group using an educational video method and the second group with a role-playing method. Data were collected before, immediately, and 15 days after training using a questionnaire covering the three domains of demographic information, triage knowledge, and triage performance. The data were analyzed using defined knowledge and performance parameters. There was no significant difference between the two training methods on performance and immediate knowledge (P = .2), lasting knowledge (P=.05) and immediate performance (P = .35), but there was a statistical advantage for the role-playing method on lasting performance (P = .02). The two educational methods equally increase knowledge and performance, but the role-playing method may have a more desirable and lasting effect on performance.

Assessment of knowledge and skills of triage amongst nurses working in the emergency centres in Dar es Salaam, Tanzania

The triage nurse in the emergency centre (EC) is the first person that a patient encounters and the triage nurses’ knowledge has been cited as an influential factor in triage decision-making. The purpose was to assess the triaging knowledge and skills of nurses working in the ECs in Dar es Salaam, Tanzania. Both descriptive cross-sectional and observational study designs were used and data was collected using a structured questionnaire, an observation checklist and a triage equipment audit record. The study population was all nurses (enrolled and registered) working within the EC of the national hospital and three municipal district hospitals in Dar es Salaam. Descriptive statistical data analysis was carried out using SPSS 13.0. Thirty three percent (20/60) of the respondents were not knowledgeable about triage. Thirteen percent of the respondents reported that although they had attended workshops, there had been a lack of information on how to triage patients. More than half (52%) of the respondents were not able to allocate the patient to the appropriate triage category. Fifty eight percent (35/60) of the respondents had no knowledge on waiting time limits for the triaged categories. Among the four hospitals observed, only one had nurses specifically allocated for patients’ triage. The respiratory rate of patients was not assessed by 84% of the triage nurses observed. No pain assessment was done by any of the triage nurses observed. Only one out of four ECs assessed had triage guidelines and triage assessment forms. Nurses who participated in this study demonstrated significant deficits in knowledge and skills regarding patients’ triaging in the EC. To correct these deficits, immediate in-service training/education workshops should be carried out, followed by continuous professional development on a regular basis, including refresher training, supportive supervision and clinical skills sessions. L’infirmier de triage dans un centre d’urgence (CU) est la première personne qu’un patient rencontre et les connaissances des infirmiers de triage ont été citées comme un facteur influençant la prise de décisions relatives au triage. L’objectif consistait à évaluer les connaissances et compétences en matière de triage des infirmiers travaillant dans les CU à Dar es Salaam, en Tanzanie. Des conceptions d’étude à la fois descriptive et transversale ont été utilisées et les données recueillies par le biais d’un questionnaire structuré, d’une liste de contrôle des observations et d’un registre de la vérification de l’équipement de triage. La population étudiée comprenait l’ensemble des infirmiers (recrutés et diplômés d’Etat) travaillant dans le CU de l’hôpital national et de trois hôpitaux de quartier municipaux à Dar es Salaam. L’analyse des données statistiques descriptive a été réalisée en utilisant SPSS 13.0. Trente trois pour cent (20/60) des sondés ne disposaient d’aucune connaissance sur le triage. Treize pour cent des sondés ont déclaré que bien qu’ils aient participé à des ateliers, les informations sur la façon d’effectuer un triage des patients étaient insuffisantes. Plus de la moitié (52%) des sondés n’étaient pas en mesure d’affecter le patient à la catégorie de triage appropriée. Cinquante huit pour cent (35/60) des sondés n’avaient aucune connaissance sur les limites en termes de temps d’attente pour les catégories de triage. Dans les quatre hôpitaux observés, seulement un disposait d’infirmiers spécifiquement affectés au triage des patients. 84% des infirmiers de triage observés n’évaluaient pas la fréquence respiratoire des patients. Aucun des infirmiers de triage observés ne réalisait d’évaluation de la douleur. Seulement un des quatre CU disposait de directives relatives au triage et de formulaires d’évaluation du triage. Les infirmiers qui ont participé à cette étude ont montré des lacunes significatives en termes de connaissances et compétences relatives au triage des patients dans le CU. Pour traiter ces lacunes, des ateliers de formation/éducation sur le tas immédiats devraient être organisés, suivis d’un perfectionnement professionnel continu régulier, notamment une formation de remise à niveau, une supervision de soutien et des sessions de compétences cliniques.

Relationships between Triage Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses in East Java, Indonesia

Background: Since there are increased numbers of clients with traumatic injuries and non-traumatic cases in the emergency department in Indonesia, triage skill is an essential competency required for the emergency nurses. Purposes: This study aimed to examine the level of perceived triage skills and the relationship between knowledge, training, working experience and perceived triage skills among emergency nurses. Method: Two hundred and sixty six emergency room (ER) nurses working in two secondary and two tertiary public hospitals in East Java Province, Indonesia, were recruited by purposive sampling. Data were collected using a set of questionnaires which included the Demographic Data including training and working experiences, Triage Knowledge Questionnaire (TKQ) and Triage Skill Questionnaire (TSQ). The contents of questionnaires were validated by three experts and tested for reliability. The correlation coefficient for the TKQ was 0.99 and Cronbach’s alpha coefficient of the TSQ was 0.93. The collected data were analyzed using descriptive statistics including Pearson’s product-moment correlation to examine the relationship. Result: The results showed that the majority of subjects were female (71.4%) with aged of 22 – 40 years (79.3%), educated to diploma level (94.4%). All subjects had attended Basic Life Support (BLS) and Advanced Life Support (ACLS), and about half of them had greater than 5 years working experiences in ED. Overall perceived triage skill was at a moderate level with the mean score of 75.12 (SD = 11.23). There were significantly positive correlations between triage skill and working experience (r = .27, p < .01), training experience (r = .37, p < .01), and triage knowledge (r = .38, p < .01). Conclusion: The findings provide a better understanding of triage skills among ER nurses and suggest that the continuing education and training courses related to triage and advanced management of medical emergencies for ER nurses are required in order to increase and update the triage skills in enhancing the quality of emergency care and patient safety. Key Words :Triage knowledge, triage skills, training, working experience, emergency nurse

(A45) When Nothing is Left Standing: Nursling's Integral Role during Disaster Response in Indonesia and Haiti

The purpose of this presentation is to compare the lessons learned in acute nursing care in the post-disaster settings of Aceh Jaya, Indonesia (2004) and Port-au-Prince, Haiti (2010). The impact of such disasters disproportionally affects populations made vulnerable by poverty, marginalization, and structural violence. The recognition of these vulnerabilities heightens the role of the nurse as an advocate for the ill and injured. In addition, the lack of adequate human and material resources on all levels necessitates insisting on best practices for patient care despite the resource constraints. Consideration of best practices begins with rigorous personnel selection of nurses adequately trained in emergency/critical care, complex humanitarian emergencies, and disaster response. A proficient level of resource-specific triage knowledge is required to adequately provide the most effective care to patients. Not infrequently, disaster nursing care involves being tasked with a clinical skill or procedures that would be outside the scope of practice in the home country. While the expansion to such practices often is justified by need, an ethical framework demands consideration of the central tenet of “first do no harm”. A heavy burden of coordination among other caregivers, family, and the local staff is required by nurses in this environment. The substantial challenges include communication and continuity of care during the initial response phase among multiple partners with varied backgrounds and goals. Drawing from experiences in Haiti and Aceh, this presentation seeks to define the best practices in disaster nursing care and explore the ethical considerations that arise in such challenging environments.

Triage knowledge and skills among emergency nurses in East Java Province, Indonesia

Triage knowledge and skills among emergency nurses in East Java Province, Indonesia

Teaching Mass Casualty Triage Skills Using Iterative Multimanikin Simulations

Objective. Effective mass casualty triage requires rapid andaccurate decision making. First responders need to be trained, but opportunities to practice triage andreceive individualized feedback during traditional mass casualty (MC) exercises are uncommon. It was hypothesized that novice learners would improve in speed, accuracy, andself-efficacy after deliberate practice triaging multiple simulated casualties in a MC exercise using high-fidelity manikins. Methods. Learners initially developed baseline knowledge of MC triage by listening to four short podcasts andpassing a written examination. They then experienced three sequential MC scenarios (A, B, andC) consisting of five manikin simulations each, coupled with individual feedback after each scenario. Students served as their own controls. A triage score (TS) andintervention score (IS) were recorded. For the TS, one point was awarded for each correctly identified main problem, required intervention, andtriage category. For the IS, one point was awarded for each correctly applied intervention. Before-and-after surveys measured self-efficacy andreaction to the training. Results. Twenty-one medical students were enrolled and20 students passed the examination. The TS andIS improved significantly during scenario B (p < 0.001). Time to complete each scenario decreased significantly from scenario A (8 min 27 sec) to scenario B (6 min 19 sec) (p < 0.001), but not from scenario B to scenario C (5 min 40 sec). Self-efficacy improved significantly after scenario C for prioritizing treatment andresources, identifying high-risk casualties, andlearning to be an effective first responder. Conclusion. Novice learners demonstrated improved triage andintervention scores, speed, andself-efficacy during an iterative, multimanikin MC training experience

Mass Casualty Triage Knowledge of Military Medical Personnel

During battlefield and mass casualty incidents, triage has been traditionally performed by many different personnel, including medics, nurses, dentists, and physicians. The objective of this study was to determine which military medical providers are most knowledgeable in mass casualty triage. The design was a prospective, written, timed, case-based examination of triage knowledge. Participants were volunteers from the active duty medical (physician), dental, nursing, and enlisted corps of the three military services. Subjects completed a 16-minute written examination consisting of seven cases in each of three simulated mass casualty scenarios: combat; nuclear, biological, and chemical; and humanitarian. Tests were taken anonymously, although demographic data on medical specialty, training, and experience were collected. Participants were instructed to classify the cases using the NATO categories of immediate, delayed, minimal, or expectant. Scores were tabulated according to two grading scales: an absolute scale of number correct, and a weighted scale amplifying gross misclassifications. Median scores between groups were tested pairwise using the Kruskal-Wallis one-way analysis of variance with p < or = 0.05. Statistically significant differences were noted between the highest and lowest scoring groups in each scenario. Our conclusion is that among the subject groups tested, physicians were best at mass casualty triage. Dentists, nurses, and medics scored progressively less well on our examination.