Emergency Department Triage Decisions: Personnel and Parameters

Abstract

Objectives: Triage aims to determine the clinical priority of patients based on their presenting features. Scoring systems-including physiological parameters-to predict mortality have been described, but in most triage methods used in emergency departments, vital signs or laboratory parameters are not included as standard assessments. The objective of this study was to measure agreement and acuity on the urgency of an emergency department patient between the points of views of healthcare professionals. We also sought to determine which vital signs and parameters affect triage decision by creating several mods with different parameters. Materials and Methods: This prospective study was carried out on 550 patients referred to an academic emergency department. The patients triage levels were determined by nurses, intern doctors, residents and emergency physicians. Eleven mods were defined with several components, for each mod 50 patients were selected. To evaluate the agreement between raters triage decisions, the chance-adjusted measure of agreement kappa was calculated. Results: Of the 550 patients included in the study, agreement for nurses was 0.374, kappa value between interns and physician was 0.257, and a value of 0.311 was found for residents. Conclusion: In emergency medicine, there is a strong need for sensitive tools to identify and characterize patients at admission to the emergency department. According to our results, the most important parameters affecting triage decision were found to be oxygen saturation and Glasgow Coma scale

Keywords

• Agreement
• Emergency Department
• Reliability Triage
• Vital Signs

Ethical Statement

This study was approved by the Ankara University Faculty of Medicine Ethics Committee (approval number: 13-629-16).

Acil Servis Departmanı Triyaj Kararları: Sağlık Çalışanları ve Parametreler

Abstract

Amaç: Triyaj acil tıbbi bakımı bekleyebilecek olanlar ile bekleyemeyecek olanların ayrılması için yapılan uygulamadır. Mortaliteyi öngörmek için fizyolojik parametreler de dahil olmak üzere skorlama sistemleri tanımlanmıştır, ancak acil servislerde kullanılan çoğu triyaj yönteminde, vital bulgular veya laboratuvar parametreler standart değerlendirmeler olarak dahil edilmemiştir. Bu çalışmanın amacı, acil servise başvuran hastaların triyaj kararını farklı sağlık çalışanları arasındaki uyuşmalarını ölçmektir. Ayrıca, farklı parametrelerle modlar oluşturarak hangi vital bulguların ve parametrelerin triyaj kararını etkilediğini belirlemeyi amaçladık. Gereç ve Yöntem: Bu prospektif çalışma, bir akademik acil servise başvuran 550 hasta üzerinde gerçekleştirildi. Hastaların triyaj düzeyleri hemşireler, stajyer doktorlar, asistanlar ve acil tıp uzmanları tarafından belirlendi. Farklı parametreler içeren 11 mod belirlenmiştir ve her mod için 50 hasta tanımlanmıştır. Uygulayıcıların triyaj kararları arasındaki anlaşmayı değerlendirmek için, kappa uyumluluk testi kullanılmıştır. Bulgular: Çalışmaya dahil edilen 550 hasta için, kappa uyumluluk değeri hemşireler için 0,374, intörn doktorların; 257, asistanlar için 0,311 bulunmuştur. Sonuç: Acil tıpta, acil servise kabul edilen hastaları tanımlamak için hassas araçlara güçlü bir ihtiyaç vardır. Sonuçlarımıza göre triyaj kararını etkileyen en önemli parametreler oksijen satürasyonu ve Glasgow Koma skalası olduğu tespit edilmiştir.

Keywords

• Uyumluluk
• Acil Servis
• Güvenilir Triyaj
• Vital Bulgular

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