Triage Procedures Research Articles

Nursing student's attitudes toward teams in an undergraduate interprofessional mass casualty simulation.

Interprofessional education (IPE) aims to prepare future nurses for collaboration with healthcare professionals. Army style lane training may be an effective pedagogical technique for delivering emergency care and mass casualty training while incorporating IPE. This study sought to determine attitudes towardIPE and teamwork in pre-licensure, undergraduate nursing students following a lane training simulation. Pre- and postsimulation surveys containing sociodemographic, reflection, and KidSIM Attitude Toward Teamwork in Training Undergoing Designed Educational Simulation (KidSIM) items (Sigalet et al.,2012) were conducted. The KidSIM tool was deemed reliable (α = .98). Paired sample t tests resulted in significant increases for the KiDSIM and its subscales, with the exception of communication. However, communication, along with situation assessment and teamwork were reported to be most enhanced by students. Results support using the Army lane training model in an IPE environment for teaching emergency care, triage, and mass casualty procedures.

Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic.

BackgroundTriage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID‐19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting.Materials and MethodsThis retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID‐19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed.ResultsA self‐report triage questionnaire identified 6% of triage‐positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%–85.4%), a specificity of 94.3% (95% CI, 93.5%–95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%–8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13–2.53, p = .01), younger age (OR, 1.52; 95% CI, 1.15–2.01, p < .01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44–16.6, p < .0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission.ConclusionA self‐report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) symptoms. Differential diagnosis with tumor‐ or treatment‐related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS‐CoV‐2 testing should be implemented to identify asymptomatic carriers.Implications for PracticeThis is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire‐based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) symptoms, and a differential diagnosis with tumor‐ or treatment‐related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS‐CoV‐2 infection should be implemented to identify asymptomatic carriers.

Liability and legal security of healthcare professionals in the context of a pandemic

This paper deals with the relevance of bioethical guidelines for the prioritization of patient care. These guidelines should guide health professionals' triage procedures in exceptional situations of resource shortage. Also, they would contribute to evaluate the legal liability of professionals in these situations.

Automated remote decision-making algorithm as a primary triage system using machine learning techniques

Objective. An objective and convenient primary triage procedure is needed for prioritizing patients who need help in mass casualty incident (MCI) situations, where there is a lack of medical staff and available resources. This study aimed to develop an automated remote decision-making algorithm that remotely categorize a patient’s emergency level using clinical parameters that can be measured with a wearable device. Approach. The algorithm was developed according to the following procedures. First, we used the National Trauma Data Bank data set, a large open trauma patient data set assembled by the American College of Surgeons (ACS). In addition, we performed pre-processing to exclude data when the vital sign or consciousness indicator value was missing or physiologically in an abnormal range. Second, we selected the T-RTS method, which classifies emergency levels into four classes (Delayed, Urgent, Immediate and Dead), as the primary outcome. Third, three machine learning methods widely used in the medical field, logistic regression, random forest, and deep neural network (DNN), were applied to build the algorithm. Finally, each method was evaluated using quantitative performance indicators including the macro-averaged f1 score, macro-averaged mean absolute error (MMAE), and the area under the receiver operating characteristic curve (AUC). Main results. For total sets, the logistic regression had a macro-averaged f1 score of 0.673, an MMAE of 0.387 and an AUC value of 0.844 (95% CI, 0.843–0.845), while the random forest and DNN had macro-averaged f1 scores of 0.783 and 0.784, MMAEs of 0.297 and 0.298 and AUC values of 0.882 (95% CI, 0.881–0.883) and 0.883(95% CI, 0.881–0.884), respectively. Significance. In a comprehensive analysis of these results, our algorithm demonstrated a viable approach that could be practically adopted in an MCI. In addition, it can be employed to transfer patients and to redistribute available resources according to their priorities.

Platform for Healthcare Promotion and Cardiovascular Disease Prevention.

This article presents the hardware-software design and implementation of an open, integrated, and scalable healthcare platform oriented to multiple point-care scenarios for healthcare promotion and cardiovascular disease prevention. The platform has the capability to provide continuous monitoring, extended device integration, strategies based on artificial intelligence for the information analysis and cybersecurity support, delivering a secure end-to-end hardware-software solution. This platform is used to perform the remote patient health monitoring and supervision by doctors, triage procedures in hospitals, or self-care monitoring using personal devices such as tablets and cellphones. The proposed hardware architecture facilitates the integration of biomedical data acquired from different health-point cares, collecting relevant information for the detection of cardiovascular risk through deep-learning algorithms. All these characteristics make our development a strong tool to perform epidemiological profiling and future implementation of strategies for comprehensive cardiovascular risk intervention. The components of the platform are described, and their main functionalities are highlighted.

Contribution to the Assessment of the Quality of the Pre-Analytical Phase of Medical Biology Tests at the Ibn Sina University Hospital in Rabat

The study of the nonconformities (NC) literatures in medical biology report that between 60-85% of laboratory errors are produced during the pre-analytical phase, which are often external and escapes the biologist's control. The objective of our study was to identify the factors at the origin of non-conformities during this phase at the University Hospital of Rabat. A mixed analytical descriptive study realized between August 2019 and August 2020 based on a non-compliance form, a self-questionnaire, an observation grid, focus groups and semi-structured interviews. We also set up the Deming wheel PDCA as well as the work tools (BRAINSTORMIN, 5M, ISHIKAWA). Our results show that 22 % of the prescriptions of biologic tests are drafted by nurses and not doctors this in the absence of an updated list of biological exams. The samples are taken at 88,1% by unqualified personnel and 95 % without any guide or manual. For the traceability aspect, the name of the sampler is never placed on the sheet of examination, age, sex of the patient; time and nature of the sample are often not mentioned in the label vials of samples. Transportation is made by pneumatic cylinder system and sometimes by unqualified staff in absence of procedures for packaging and transportation equipment without traceability. The reception of samples is carried out by untrained staff on the error management of the pre-analytical phase. They result at first from a major defect of coordination between the laboratory and the services, then by the lack of continuing education and the weak competence of the staff involved in this process and finally compounded by the lack of manual sampling, procedures for packaging, transport, reception and triage.

Recommendations of the Laparoscopic Surgery Society of Nigeria on the Conduct of Minimal Access Surgeries during and after the COVID-19 Pandemic in Nigeria.

Background:COVID-19 pandemic has affected surgical practice worldwide. Laparoscopic procedures utilizing gas for pneumoperitoneum require specific consideration.Method:A panel of experts of the Laparoscopic Surgery Society of Nigeria (LASSON) was constituted to draft recommendations on the conduct of minimal access surgical (MAS) procedures during and after the pandemic in Nigeria.Results:The Society strongly believes that laparoscopy and other (MAS) procedures can be safely performed during and after the current COVID-19 pandemic if appropriate safety measures are adhered to. The Society therefore makes the following recommendations for all units performing MAS in Nigeria: (1) Design clear cut measures to navigate the pandemic in each hospital. (2) Triage surgical services and procedures. (3) Encourage screening and testing of all patients (4) Provide adequate patient communication and consenting (5) Ensure compulsory use of Personal Protective Equipments (PPEs) (6) Minimize preoperative and intraoperative personnel (7) Envisage postoperative respiratory challenges and make adequate preparation for respiratory support: (8) Make specific considerations for the confirmed COVID 19 positive patients:(9) Private facilities offering MAS and endoscopic procedures should take special measures during the pandemic (10) Know your limits.Conclusion:The Society encourages all MAS practitioners to adhere to these recommendations.

Wildlife nursing - part one: an introduction and literature review

: Nursing of British wildlife species are not included in the curricula for most veterinary nursing training programmes. Yet, when presented with wildlife casualties in practice, veterinary nurses (VNs) are expected to fulfil their professional, legal and ethical responsibilities towards them. Part one of this article will discuss these responsibilities along with the triage procedures, expenses, risks and admission procedures of wildlife presented in veterinary practice.

AN ANALYSIS OF CONTRIBUTING FACTORS IN NURSES’ ACCURACY WHILE CONDUCTING TRIAGE IN EMERGENCY ROOM

Triage is aimed to arrange treatment priority to patients with different levels of urgency.These nurses who are responsible for triage must conduct standardized procedure. Hence,these nurse must acquire certain competency required to conduct triage. The competencyincludes basic knowledge, skills and attitude. Besides that, there are several contributingfactors playing significant role in triage procedure implementation, which is intrinsicfactors. Regarding to those factors, this study aimed to analyze those contributing factorsaffecting nurses’ accuracy in doing triage procedure in emergency room. This studyemployed correlational analytic design accompanied with cross sectional approach. Thepopulation in this study was all nurses who worked actively in the Emergency Room atRSUD in Malang Regency and Blitar City and thirty two respondents are taken as thesamples using population total method. The data is collected using observation sheetand questionnaire. The data analyzed through Partial Least Squares (PLS). It is showedthat knowledge level (p-value 0.000), skill level (p-value 0.000), attitude (p-value 0.000),intrinsic factors (p-value 0.000) are related to nurses’ accuracy in implementing triageprocedure. Therefore, based on those findings, the hospital’s management is suggested toimprove their nurses’ competency in implementing triage, especially by recommendingthem to participate in advanced emergency training and triage course.

Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations.

Since the COVID‐19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high‐quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID‐19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early‐stage and advanced‐stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID‐19 as well as from cancer not adequately addressed and treated.

Adult cardiovascular surgery and the coronavirus disease 2019 (COVID-19) pandemic: the Italian experience.

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected all health care professionals. The outbreak required a thorough reorganization of the Italian regional local health care system to preserve resources such as ventilators, beds in intensive care units and surgical and anaesthesiological staff. Levels of priority were created, together with a rigorous triage procedure for patients with COVID-19, which led to postponement of all elective procedures. Urgent cases were discussed with the local heart team and percutaneous approaches were selected as the first treatment option to reduce hospital stay. COVID-19 and COVID-19-free pathways were created, including adequate preparation of the operating room, management of anaesthesiological procedures, transportation of patients and disinfection. It was determined that patients with chronic diseases were at increased risk of adverse outcomes. Systemic inflammation, cytokine storm and hypercoagulability associated with COVID-19 increased the risk of heart failure and cardiac death. In this regard, the early use of extracorporeal membrane oxygenation could be life-saving in patients with severe forms of acute respiratory distress syndrome or refractory heart failure. The goal of this paper was to report the Italian experience during the COVID-19 pandemic in the setting of cardiovascular surgery.

S3295 SARS-CoV-2 and the Gastrointestinal (GI) System: A Structured Review

INTRODUCTION: The SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. While SARS-CoV-2 infection predominantly results in respiratory illness, the effect on the GI system is emerging. This review summarizes what is known about the effects of SARS-CoV-2 infection in the GI system. It also identifies knowledge gaps and suggests future research directions. METHODS: Relevant articles from a Pubmed search were reviewed and the findings summarized. RESULTS: Manifestations of SARS-CoV-2 infection in the GI system include non-specific symptoms such as nausea, vomiting, abdominal pain, and diarrhea. Incidence of liver injury ranges between 15 - 53%, with marked dysfunction in liver chemistry seen in severe infections. The exact mechanism(s) for the GI effects seen in SARS-CoV-2 infection remains unclear. CONCLUSION: Several plausible mechanisms have been hypothesized and the leading theory suggests SARS-CoV-2, utilizes the angiotensin-converting enzyme-II receptor expressed in hepatocytes, cholangiocytes, and other regions of the GI tract as a functional receptor for cellular entry, and ultimately induces direct cellular damage. Other proposed mechanisms include immunological damage from excessive inflammatory responses – cytokine storm, drug-related injury, as well as hypoxia secondary to pneumonia. SARS-CoV-2 has 80% genomic sequence homology with SARS-CoV, and it demonstrates viral shedding from the GI tract that may precede respiratory and other clinical symptoms and persist long after resolution of respiratory symptoms. This fecal source could lead to infective aerosol generation and fomite transmission. There is paucity of research on the interaction of existing liver conditions with SARS-CoV-2 infection and the effect on treatment outcomes. In conclusion, a clearer understanding of the specific mechanisms through which the virus attacks the GI tract will be helpful in directing timely and effective treatment options, as well as possibly mitigating long-term complications. In patients with GI affectation with concomitant liver injury, treatment choices should be tailored to limit further hepatic injury. Clinicians need to be alert to GI symptoms of SARS-CoV-2, especially in the absence of respiratory symptoms and this knowledge should influence personal protective equipment strategy during triage and GI procedures. More research into the role liver pathologies play in modulating hepatic injury in patients with SARS-CoV-2 infection is needed.

1741P Triage procedures for COVID-19 in an Italian cancer centre

The recent COVID-19 outbreak in Italy required timely adoption of efficient triage procedures (TPs) with the aim to minimize the risk of infection spreading in the hospitals. We developed a written questionnaire (items explored: fever, respiratory symptoms, previous contacts or personal positivity for COVID-19) together with body temperature (BT) measurement, to intercept patients (pts) with suspect of COVID-19 infection.

Management plan of a paediatric outpatient department during the SARS-CoV-2 epidemic.

With the novel coronavirus (2019-nCoV) infection outbreak and spread, serious cases of infection and neonatal infection have been reported. Moreover, children show milder cases and a better prognosis than adults. The outpatient Department of Paediatrics has played a crucial role in the prevention and control of novel coronavirus (2019-nCoV) infection in children. Based on previous experience and existing diagnosis and treatment guidelines, we present the relevant strategies of this particular paediatric outpatient department when responding to the epidemic. Conclusion: Concurrently, we hope that this article can act as a reference in the fight against SARS-CoV-2 infection. Further modifications will be made in the future with the increase in clinical experience and changes in the disease. This article is protected by copyright. All rights reserved.

Universal screening of high-risk neonates, parents, and staff at a neonatal intensive care unit during the SARS-CoV-2 pandemic.

Since February 21, 2020, SARS-CoV-2 has spread exponentially worldwide. Neonatal patients needing intensive care are considered a vulnerable population. To report the results of a policy based on multi-timepoint surveillance for SARS-CoV-2 of all neonates admitted to the neonatal intensive care unit (NICU), their parents, and all healthcare providers in a part of Italy with a high prevalence of the infection. Observational study conducted from 21 February to 21 April 2020. Intervention consisted of (a) parental triage on arrival at the neonatal ward; (b) universal testing with nasopharyngeal swabs and blood testing for SARS-CoV-2 IgM and IgG antibodies; (c) use of continuous personal protective equipment at the NICU by parents and staff. A total of 6726 triage procedures were performed on 114 parents, and 954 nasopharyngeal swabs were collected from 226 individuals. Five (2.2%) asymptomatic individuals (2 parents and 3 healthcare providers) tested positive on nasopharyngeal swabs and were kept isolated for 14 days. Of 75 admitted newborn, no one tested positive on nasopharyngeal swabs or antibody tests. Three parents presented with fever or flu-like symptoms at triage; they tested negative on swabs.Conclusion: With universal screening of neonates, parents, and staff, there were no cases of SARS-CoV-2 infection among the neonates admitted to a NICU in an area with a high incidence of SARS-CoV-2. Our experience could be usefully compared with other strategies with a view to developing future evidence-based guidelines for managing high-risk neonates in case of new epidemics.What is Known:• The novel coronavirus named SARS-CoV-2 has since spread worldwide at a remarkable rate, with more than 2.5 million confirmed cases.• Pediatric population may be less affected from COVID-19 than adult population but infants and newborn babies seem to be more vulnerable to SARS-CoV-2 infection.What is New:• Using an approach based on triage; testing with nasopharyngeal swabs and serology; and use of personal protective equipment, there were no cases of SARS-CoV-2 infection among neonates in a NICU in a high incidence of SARS-CoV-2 area.• Positive and asymptomatic individuals were identified and isolated early allowing the containment of infection’s spread among healthcare providers and parents.

What presents to a rural district emergency department: A case mix.

BackgroundThere is little information available on the range of conditions presenting to generalist run rural district hospital emergency departments (EDs) which are the first point of acute care for many South Africans.AimThis study aims to assess the range of acute presentations as well as the types of procedures required by patients in a rural district hospital context.SettingZithulele is a 147-bed district hospital in rural Eastern Cape.MethodsThis is a cross-sectional study assessing all patients presenting to the Zithulele hospital emergency department from 01 October 2015 to 31 December 2015. Data collected included the triage acuity using the South African Triage Scale system, patient demographics, diagnosis, outcome and procedures performed. Diagnoses were coded retrospectively according to the international statistical classification of diseases and related health problems version 10 (ICD 10).ResultsOf the 4 002 patients presenting to the ED during the study period, 2% were triaged as emergencies and 45% as non-urgent. The most common diagnostic categories were injuries, infections and respiratory illnesses respectively. Diagnoses from all broad categories of the ICD-10 were represented. 67% of patients required no procedure. Diagnostic procedures (n = 877) were more prevalent than therapeutic procedures (n = 377). Only 2.4% of patients were transferred to a referral centre acutely.ConclusionPatients with conditions from all categories of the ICD-10 present for management at rural district hospitals. Healthcare professionals working in this setting need to independently diagnose and manage a wide range of ED presentations and execute an assortment of procedures.

Recommendations for Deep Brain Stimulation Device Management During a Pandemic.

Most medical centers are postponing elective procedures and deferring non-urgent clinic visits to conserve hospital resources and prevent spread of COVID-19. The pandemic crisis presents some unique challenges for patients currently being treated with deep brain stimulation (DBS). Movement disorder (Parkinson’s disease, essential tremor, dystonia), neuropsychiatric disorder (obsessive compulsive disorder, Tourette syndrome, depression), and epilepsy patients can develop varying degrees of symptom worsening from interruption of therapy due to neurostimulator battery reaching end of life, device malfunction or infection. Urgent intervention to maintain or restore stimulation may be required for patients with Parkinson’s disease who can develop a rare but potentially life-threatening complication known as DBS-withdrawal syndrome. Similarly, patients with generalized dystonia can develop status dystonicus, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures as a result of therapy cessation. DBS system infection can require urgent, and rarely emergent surgery. Elective interventions including new implantations and initial programming should be postponed. For patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient’s tolerance to potential therapy disruption. Scheduling of the procedures, however, depends heavily on the hospital system regulations and on triage procedures with respect to safety and resource utilization during the health crisis.

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Consensus on Pre-examination and Triage in Clinic of Dermatology During Outbreak of COVID-19 From Chinese Experts.

The 2019 novel coronavirus infection has brought a great challenge in prevention and control of the national epidemic of coronavirus disease 2019 (COVID-19) in China. During the fight against the epidemic of COVID-19, properly carrying out pre-examination and triage for patients with skin lesions and fever has been a practical problem encountered in hospitals for skin diseases as well as clinics of dermatology in general hospitals. Considering that certain skin diseases may have symptom of fever, and some of the carriers of 2019 novel coronavirus and patients with COVID-19 at their early stage may do not present any symptoms of COVID-19, to properly deal with the visitors to clinics of dermatology, the Chinese Society of Dermatology organized experts to formulate the principles and procedures for pre-examination and triage of visitors to clinics of dermatology during the epidemic of COVID-19.

The role of triage in the prevention and control of COVID-19.

To prevent and control public health emergencies, we set up a prescreening and triage workflow and analyzed the effects on coronavirus disease 2019 (COVID-19). In accordance with the requirements of the level 1 emergency response of public health emergencies in Shaanxi Province, China, a triage process for COVID-19 was established to guide patients through a 4-level triage process during their hospital visits. The diagnosis of COVID-19 was based on positive COVID-19 nucleic acid testing according to the unified triage standards of the Guidelines for the Diagnosis and Treatment of Novel Coronavirus Pneumonia (Trial version 4),4 issued by the National Health Commission of the People's Republic of China. The screened rate of suspected COVID-19 was 1.63% (4 of 246) in the general fever outpatient clinic and 8.28% (13 of 157) in the COVID-19 outpatient clinic, and they showed a significant difference (P = .00). The triage procedure effectively screened the patients and identified the high-risk population.