EVALUATION OF THE ACCURACY OF THE EMERGENCY DEPARTMENT'S NURSES’ TRIAGE DECISION USING THE ESI SYSTEM

Year 2023, Volume: 5 Issue: 3, 89 - 95, 27.12.2023

Gültekin Akyol , Cem Oktay , Fatma Selman

https://doi.org/10.55994/ejcc.1352144

Abstract

Objective: Emergency triage is extremely important in reducing morbidity and mortality. The aim of this study is to compare the accuracy of triage categorization decisions of triage nurses with the Emergency Severity Index (ESI) system categorization determined after the emergency room evaluation of patients.

Materials and Method: In this descriptive, cross-sectional study, patients who were admitted to Akdeniz University Hospital Emergency Service Adult Triage Area between 01-14 March 2018 and then admitted to the emergency department were evaluated retrospectively.

Results: Triage scores of 3324 patients were analyzed. The kappa concordance value between the score of the triage nurse and the scores of the physicians using ESI was found to be 0.416. It was determined that the triage staff gave a triage score 1/4 lower than the ESI. In the presence of tachypnea, an increase in the low triage rate and a decrease in the high triage rate of the patients were found. It was determined that the most accurate triage scores were given in nephrological and cardiovascular disorders. The most faulty triage decisions were eye disorders and oncological emergencies. In patients between the ages of 18-65, statistically significantly higher triage was performed. Patients with chronic diseases and a history of continuous drug use were given lower triage.

Conclusion: In order to increase the accuracy of triage, it is necessary to increase the medical knowledge of the triage nurse and to provide practical training especially on real cases with a triage score of 2-4.

Keywords

emergency, triage decision, patient management

Ethical Statement

Before the study, approval was obtained from the Akdeniz University Faculty of Medicine Clinical Research Ethics Committee (Decision number: 16.05.2018 - 340).

References

• 1. Shiber JR, Longley MB, Brewer KL. Hyper-use of the ED. Am J Emerg Med 2009;27:588-94.
• 2. Pines JM, Prabhu A, McCusker CM, Hollander JE. The effect of ED crowding on education. Am J Emerg Med 2010;28:217-20.
• 3. Iserson KV, Moskop JC. Triage in medicine, part I: Concept, history, and types. Ann Emerg Med 2007;49:275-81.
• 4. Ünalan Gedik H. Afetlerde Triyaj ve Komuta Sistemi. Erişim tarihi: 08 Mayıs 2018. http://www.acilveilkyardim.com/acilbakim/triyaj.html.
• 5. Dong SL, Bullard M: Emergency department triage. In Rowe B, Lang E, Brown M et al (eds): Evidence-Based Emergency Medicine. Oxford, WileyBlackwell, 2009, pp 58-65.
• 6. Gilboy N, Tanabe P, Travers DA, Rosenau AM, Eitel DR. Emergency Severity Index, Version 4: Implementation Handbook. AHRQ Publication No. 05- 0046-2. Rockville, MD: Agency for Healthcare Research and Quality. May 2005.
• 7. Dong SL, Bullard M: Emergency department triage. In Rowe B, Lang E, Brown M et al (eds): Evidence-Based Emergency Medicine. Oxford, WileyBlackwell, 2009, pp 58-65.
• 8. Tanabe P, Gimbel R, Yarnold PR, Adams JG: The Emergency Severity Index (Version 3) 5-level triage system scores predict ED resource consumption. J Emerg Nurs. 2004;30:22-9.
• 9. Wuerz RC, Travers D, Gilboy N, Eitel DR, Rosenau A: Implementation and refinement of the Emergency Severity Index. Acad Emerg Med. 2001;8:170-6.
• 10. Baumann MR, Strout TD. Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients. Acad Emerg Med. 2005;12:219-24.
• 11. Bruijns SR, Wallis LA, Burch VC: A prospective evaluation of the Cape Triage Score in the emergency department of an urban public hospital in South Africa. Emerg Med J. 2008;25:398-402.
• 12. Rahmani F, Majd PS, Bakhtavar HE, Rahmani F. Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis. J Emerg Pract Trauma 2018;4:9-13.
• 13. Esmailian M, Zamani M, Azadi F, Ghasemi F. Interrater agreement of emergency nurses and physicians in Emergency Severity Index (ESI) Triage. Emerg (Tehran) 2014;2:158-61.
• 14. Goransson KE, von Rosen A. Interrater agreement: a comparison between two emergency department triage scales. Eur J Emerg Med 2011;18:68-72.
• 15. Resources for optimal care of the injured patient. American College of Surgeons Committee on Trauma. Chicago, American College of Surgeons, 1999, pp 98.
• 16. Hinson JS, Martinez DA, Schmitz PSK, Toerper M, Radu D, Scheulen J, et al. Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis. Int J Emerg Med 2018;11:3.
• 17. Källberg AS, Göransson KE, Östergren J, Florin J, Ehrenberg A. Medical errors and complaints in emergency department care in Sweden as reported by care providers, healthcare staff, and patients - a national review. Eur J Emerg Med 2013;20:33-8.